Unit 4: Ch. 10,22,28 Flashcards
Define surgical asepsis
totally free of microorganisms, including spores
Medical asepsis
- antimicrobial agent used
- containing
- handwashing
- PPE/ isolation
- clean technique **
Surgical asepsis
- sterilization (physical and chemical)
- surgical hand antisepsis
Sterile techniques
practices that avoid contaminating microbe-free items
Autoclave
pressure steam sterilizer
Principles of surgical asepsis
- sterile with sterile
- partially unwrapped packaging is considered unsterile
- if you question if its sterile, consider it unsterile
- longer the time = less sterile
- expiration dates
- once an item is open its only a matter of time before it is contaminated
- if item gets wet its contaminated
- coughing,sneezing, or excessive talking over a sterile field contaminates it
- dont reach over a sterile field
- below waist level is considered contaminated
Sterile field
work area free of microorganisms
Lipping
before use of a sterile solution, pour and discard small amount of liquid from the mouth of the container to wash away airbourne contaminators
Mask
wear a mask if there is a risk for coughing or sneezing within a radius of 3 feet
Particulate filter respirator
wear if there is a potential for acquiring diseases caused by droplet or airborne transmission
Colonization
condition where microorganisms are present but there are no signs or symptoms
Course of infectious diseases
- incubation period
- prodromal stage
- acute stage
- convalescent stage
- resolution
Incubation period
infectious agents reproduces, but there are no signs or symptoms
Prodromal stage
initial symptoms appear
Acute stage
symptoms become severe and specific to the tissue or organ that is affected
Convalescent stage
symptoms subside
Resolution
pathogen is destroyed, health is restored
When do we wear PPE?
Anytime you are exposed to bodily fluids
Diseases that require isolation
- pulmonary TB
- measles (rubella)
- chicken pox (variscella)
- severe acute respiratory syndrome (SARS)
Transmission based precaution
- isolation precautions
- airborne
- droplet
- contact
Airborne
- private room
- negative air pressure
- 6 to 12 air changes per hour
Airborne protection
- follow standard precautions
- door closed
- wear PPE
- N95 mask
Airborne diseases
- pulmonary TB
- Measles
- chicken pox
- SARS
Droplet
private room
within 3ft
ciughing sneezing etc
Droplet protection
- follow standard precautions
- leave door open or closed
- wear a mask
Droplet diseases
- influenza
- rubella
- strep pneumonia
- meningitis
- whooping cough
Contact
-private room or in a room with similarly infected patients
Contact protection
- standard precautions
- don gloves before entering
- handwashing
- avoid transporting the client
- have equipment exclusively for that specific pt
Reverse isolation
- use with patients who are immunocompromised
- standard precautions AND gown, gloves, mask
- limit visitor contact
- no sick visitors
- no fresh plants or flowers
- no raw or uncooked foods
Providing sensory stimulation
- move bed
- position pt so that they can look out the window
- encourage telephone calls
- converse with pt
- encourage activity
- offer wide choice of foods
Early signs of infection in older adults
change in behavior or mental status
Visitors in isolation rooms
- plan frequent social contact
- encourage visitors to come as often as policy allows
- visitors must follow infection control precautions
Types of drainage
- serous
- sanguineous
- serosanguineous
- purulent
Serous drainage
- mostly clear or slightly yellow
- a bit thicker than water
Serosanguineous drainage
- thin and watery
- pink in color
Sanguineous drainage
- fresh bloody exudate
- bright red, thick
Purulent drainage
- thick with yellow,green, brown color
- foul odor
What type of drainage is a sign of infection?
Purulent
Gauze dressing
- made of woven cloth fibers
- ideal for covering fresh wounds that are likely to bleed or wounds that exude drainage
Transparent dressing
- clear acrylic film wound coverings
- allow nurses to assess wound without removing dressing
- commonly used to cover peripheral and central intravenous insertion sites
Hydrocolloid, hydrogel, and alginate dressings
-self adhesive, opaque, air and water occlusive
keep wound moist
First intention healing
- primary intention
- wound edges are directly next to each other
- small amount of scar tissue
Second intention healing
- wound edges are widely separated
- more time consuming and and complex reparative process
- conspicuous scar
- wound care must be performed cautiously
Third intention healing
- wound edges are intentionally left widely separated and later brought together with some kind closure material
- broad, deep scar
- extensive drainage and tissue debris
TED hose
- compression stockings
- must have physician order
- remove every 8 hours
- apply after elevating legs for 15 minutes
Drains
tubes that provide a means for removing blood and drainage from a wound
Open drains
- flat flexible tubes that empty into a dressing
- use gravity or capillary action
- can be shortened by nurse
Closed drains
- tubes that terminate in a receptacle
- Jackson pratt (PV), hemovac
- use nonmechanical vacuum or negative pressure
Vacuum assisted closure (VAC)
- wound packed with foam filler and sealed with an occlusive dressing
- attached to a suction tube and pump
Factors that negatively impact healing
- compromised circulation
- infection
- purulent, bloody, or serous fluid accumulation
- KEY TO WOUND HEALING IS ADEQUATE BLOOD FLOW*
Pressure ulcer
- decubitus ulcer
- wound caused by prolonged capillary compression that impairs circulation to the skin and underlying tissue
Pressure ulcer stage 1
- intact but reddened skin
- skin that remains red when pressure is relieved
Pressure ulcer stage 2
pressure ulcer is red and accompanied by blistering or a skin tear
Pressure ulcer stage 3
- pressure ulcer has a shallow skin crater that extends to subcutaneous tissue
- may be accompanied by serous drainage or purulent drainage
Signs & symptoms of wound infection
- discharge
- redness
- odor
- hot to the touch
Actions for suspected wound dehiscence or evisceration
- position the client to the least strain to the open area
- place sterile dressings moistened with normal saline
SALTT method
- size
- appearance
- location
- treatment
- tolerance
hyperendemic infections
infections that are highly infectious in all age groups
Open wound
one in which the surface of or the skin or mucous membrane
Closed wound
there is no opening in the skin or mucous membrane
Incision
clean separation of skin and tissue with smooth, even edges
Laceration
separation of skin and tissue in which the edges are torn and irregular
Abrasion
surface layers of skin are scraped away
Avulsion
stripping away of large areas of skin and underlying tissue, leaving cartilage and bone exposed
Ulceration
shallow crater in which the skin or the mucous membrane is missing
Puncture
opening of skin, underlying tissue or mucuos membrane caused by a narrow sharp pointed object
Contusion
injury to soft tissue underlying the skin from the force of contract with a hard object, sometimes called a bruise
Proliferation
period during which new cells fill and seal a wound
Integrity of skin and damaged tissue is restored by
- resolution
- regeneration
- scar formation
Slough
dead tissue on the wound
dehiscence
separation of wound edges
evisceration
wound separation with the protrusion of organs
montgomery straps
strips of tape with eyelets
debridement
removal of dead tissue
undermining
erosion of tissue from underneath intact skin
Normal white blood cell count
5000-10,000
Gauze
highly absorbent dressing
Temp for eye/ear irrigation
body temp
sharp debridement
removal of necrotic tissue with sterile scissors
enzymatic debridement
use of topically applied chemically substances that break down and liquify wound debris
autolytic debridement
painless, natural physiologic process that allows body enzymes to soften, liquify, and release devitalized tissue
10 microorganisms
- nonpathogens
- pathogens
- bacteria
- viruses
- fungi
- rickettsiae
- protozoans
- mycoplasmas
- helmiths
- prions
Virulence
how strong a bacteria or virus is
Means of transmission
- indirect contact
- direct contact
- vehicle
- vector
- airborne
- droplet
Antiseptics
inhibit the growth but do not kill microorganisms
Ex: alcohol
Disinfectants
destroy active microorganisms but not spores
Ex: bleach
Antimicrobial agents
chemicals that destroy or suppress the growth of infectious microorganisms
Ex: antiseptics, disinfectants, anti-infective drugs
Antibacterial
alter metabolic process of bacteria not viruses
Antiviral
control viral replication
Resident microorganisms
nonpathogens constantly present on the skin
transient microorganisms
pathogens picked up during brief contact with contaminated reservoirs
5 moments for hand hygiene
- before touching a patient
- before clean/aseptic procedure
- after body fluid exposure risk
- after touching a patient
- after touching patient surroundings
Surgical hand asepsis
- no jewelry/ watches
- antibacterial soap
- 2 to 6 minutes
- hands held above elbows
- orange sticks to clean fingernails
- friction with brush/sponge
- dry with sterile towels
- sterile gloves immediately after
Concurrent disinfection
keeping pt environment clean on a daily basis
Standard precautions
measures for reducing the risk of microorganism transmission
Standard precautions include:
- hand hygiene
- PPE
N95
- individually fitted
- can filter particles 1 micron with an efficiency of 95%
Powered air purifying respirator
-an alternative if a caregiver has not been fitted for an N95 or has facial hair
communicable disease
transmitted from one source to another by infectious bacteria or viral organisms
contagious disease
communicable disease that can spread rapidly among others, close proximity
community acquired infections
those that are not present or incubating prior to health care providers
wound
damaged skin or soft tissue
trauma
general term referring to injury
Wound repair process
- inflammation
- proliferation
- remodeling
inflammation
- lasts 2 to 5 days
- limit local damage
- remove injured cells and debris
- prepare wound for healing
Proliferation
- period during which new cells fill and seal a wound
- occurs 2 days to 3 weeks after inflammation phase
- characterized by the appearance of granulation tissue
remodeling
- period in which the wound undergoes changes and maturation
- may last 6 months to 2 years
granulation tissue
combo of new blood cells, fibroblasts, and epithelial cells
necrotic tissue
dry, brown, or black devitalized tissue
capillary action
movement of a liquid at the point of contact with a solid
sutures
knotted ties that hold incision together
staples
wide metal clips
Bandage
strip or roll of cloth wrapped around a body part
Binder
type of cloth generally applied to a particular body part like the abdomen or breast
Roller bandage principles
- elevate and support limb
- wrap from distal to proximal direction
- avoid gaps
- exert equal tension
- no wrinkles
- secure with metal clips
- check color and sensation of toes and fingers
- remove for hygiene and replace at least twice a day
mechanical debridement
physical removal of debris from nonhealing wounds
hydrotherapy
therapeutic use of water
irrigation
technique for flushing debris
wound irrigation
- before applying new dressing
- best when granulation tissue has formed
- surface tissue should be gently removed without disturbing healthy cells
eye irrigation
- flushes toxic chemical from eyes
- displaces mucus or other drainage
ear irrigation
- removes debris from the ear
- contraindicated if eardrum is perforated
- direct solution towards the roof of the auditory canal
- afterwards loosley place a cotton ball
vaginal irrigation
- aka douche
- cleansing vaginal canal
- sometimes necessary to treat infection
primary goal for wound management
reapproximate the tissue to restore its integrity
Compresses
moist,warm, or cool cloths
aquathermia pad
an electrical heating or cooling device
soak
body part is submerged in fluid to provide warmth or to apply a medicated solution
pack
commercial device for applying moist heat
Therapeutic bath
those performed for other than hygiene purposes
Most common therapeutic bath
Sitz bath: soak of the perineal area
Decubitis ulcer
pressure ulcer
locations for pressure ulcers
- sacrum
- hips
- heels
- elbows
- shoulder blades
- back of head
