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NRSG 202 > Week 2 - airborne, TB skin testing, trach, chest tubes > Flashcards

Week 2 - airborne, TB skin testing, trach, chest tubes Flashcards

1
Q

what are airborne precautions used in addition to?

A

routine precautions to prevent transmission of airborne particles

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2
Q

what do airborne precautions prevent?

A

transmission of airborne particles that remain suspended in air that can be inhaled by others in the same/ different room, or ward

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3
Q

What does a nurse need to do/wear if someone is on airborne precautions?

A
  • point of care risk assessment

- N95 respirator

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4
Q

What does a nurse need to do/wear if someone is on airborne & contact precautions?

A
  • point of care risk assessment
  • gown and gloves
  • N95
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5
Q

describe an airborne particle

A
  • organisms contained in droplet nuclei
  • small airborne particles <5 microns in size
  • result form evaporation of large droplets
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6
Q

where can airborne particles be contained?

A

debris in dust particles that remain suspended in air for long periods of time

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7
Q

what does control of airborne transmission require?

A

control of air flow through special ventilation systems and use of respirators

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8
Q

what are some specific aetiologies in regards to airborne?

A
  • measles

- tuberculosis (pulmonary or laryngeal)

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9
Q

what are some specific aetiologies in regards to airborne/contact?

A
  • monkey pox
  • smallpox
  • varicella zoster virus
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10
Q

What is an anteroom?

A
  • clean area
  • transition room to get people in/out of airborne isolation room
  • located between hallway and patients room
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11
Q

what do healthcare works use the anteroom for?

A

don and doff their N95 masks for airborne isolation

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12
Q

What is an airborne isolation room?

A

single patient room equipped with special air handling (negative pressure) and ventilation

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13
Q

describe an airborne isolation room?

A
  • ventilation has inward directional flow
  • consists of 12 air exchanges/hr
  • doors/ windows kept closed at all times even when patient not in there
  • also referred to as negative pressure rooms
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14
Q

what does an airborne isolation room require the nurse to wear?

A
  • N95 respirator that filters particles 1 micron in size
  • have a 95% filter efficiency
  • provide a face seal with <10% leak
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15
Q

What are some safety measures in regards to sharps?

A
  • wash hands
  • use appropriate equipment
  • recap sterile unused needles using scoop technique
  • use needle safety device to over used needle> never recap used needle
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16
Q

When should PPE be used in regards to sharps?

A
  • possibility of exposure to blood, body fluids or secretions
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17
Q

What are some protocols for sharps?

A
  • discard used needles in sharps container
  • change sharps container/ notify appropriate personal when 2/3 full
  • if needle injury occurs follow institutions guidelines
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18
Q

where does an intradermal injection go?

A
  • into the dermis

- located between epidermis and subcutaneous tissue

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19
Q

What medications are administered through the intradermal route?

A

common ones:

  • allergy testing
  • TB Mantoux skin test
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20
Q

How much can an intradermal injection be?

A

small amount of liquid usually 0.1mL

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21
Q

what needle is used for an intradermal injections?

A

25-27 gauge syringe that has a 1/4-1/2 inch long safety needle

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22
Q

where is TB medication stores? How long do you have to us it?

A
  • stored in fridge
  • once punctured use within 30 days
  • can be prepared my pharmacy > must be administered within 20 mins once received
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23
Q

after preparing your syringe with medication what do you. need to label it with?

A
  • 2 client identifiers
  • name of medication
  • dose and amount
24
Q

where are intradermal injections usually injected?

A

into the inner forearm away from any lesions or skin trauma

25
Q

How do you inject an intradermal injection?

A
  • insert needle 3mm into client skin with bevel up at 5-15 degree angle
  • 6-10mm wheal bleb should form
  • remove needle in opposite direction
26
Q

what happens if no wheal or bleb is formed or solution leaks out?

A

repeat test at least 2-4 inches away from initial test

27
Q

in regards to TB what do you need to document on the MAR?

A
  • date
  • dose
  • route
  • lot #
  • site location
  • measure of the wheal/bleb
28
Q

what do you need to document on the narrative notes for TB?

A
  • how Client tolerated

- if there were any adverse reactions

29
Q

What needs to be initiated for TB testing?

A

BCCDC screening form section 1 and 2

30
Q

Who can read a TB skin test and when?

A

designated HCP 48-72hrs from administration of test

31
Q

what is considered a negative TB skin test?

A

skin test of 0-4mm

32
Q

what does the TB skin test not differentiate between?

A

active TB and latent TB infection

33
Q

What should you palpate for when assessing a TB skin result?

A

induration using sweeping motion over area with your fingers

34
Q

Where do you document the results of a TB skin test?

A
  • MAR (signature/ measurement in mm not +/-)

- BCCDC TB screening form

35
Q

how do you figure out the size of TB skin result?

A
  • mark borders of induration laterally across arm

- measure area

36
Q

Who is at a higher risk of developing TB?

A
  • children <5yrs
  • people living with HIV
  • immune compromised
  • recent contact to a case of active TB with 2 years
    fibronodular disease on existing x-ray
37
Q

If a person is a contact of an active TB case what should they be assessed for?

A

window period prophylaxis (WPP) regardless of initial TST result

38
Q

What are some contraindications of repeating TB Mantoux skin test?

A
  • prior allergic reaction
  • previous positive TB skin test
  • previous active TB blood test (IGRA)
  • previous active TB disease/ latent tuberculosis
39
Q

if repeating TB Mantoux skin test is contraindicated what other tests can be done?

A

CXR and/or sputum specimens for AFB (3 consecutive)

40
Q

TB results are considered in contact with what other factors?

A
  • results used to determine if further testing/ treatment needed
41
Q

if TB results come back and person is negative what does this mean?

A
  • 0mm reaction place completed TB screening in client’s chart
  • if negative but client was a contact or has signs/ symptoms consider positive
42
Q

if TB results come back and person is positive what does this mean?

A
  • notify MRP/ ICP
  • obtain follow up orders/ directions for isolation
  • fax competed TB screening form to TB services/FP
  • email completed TB screening for to IH CD unit
  • place form in from of clients chart
43
Q

What is a tracheostomy?

A

an opening for a tube via surgical incision in the trachea just below the larynx

44
Q

What is the opening of a tracheostomy called?

A

stoma

45
Q

What are the components of a tracheostomy tube?

A
  • outer cannula with a flange
  • inner canula
  • obturator
46
Q

when taking care of someone with a tracheostomy what do you need to assess?

A
  • respiratory status
  • east of breathing
  • rate, rythme, depth
  • lung sounds
  • O2 SAT
  • pulse rate, rhythm strength
  • secretions from trach site
  • drainage on trach dressing
  • appearance of incision
47
Q

When assessing the appearance of the incision in regards to someone with a tracheostomy what does this include?

A
  • redness
  • swelling
  • purulent discharge
  • odour
48
Q

What can cause the need for a chest tube?

A

pressure placed on lungs that interferes with ling expansion due to:

  • pneumothorax
  • hemothorax
  • pleural effusion
49
Q

what is a pneumothorax ?

A

collection of air in the pleural space

50
Q

what is a hemothorax?

A

collection of blood in the pleural space

51
Q

what is a pleural effusion?

A

collection of fluid in the pleural space

52
Q

Why are chest tubes inserted?

A
  • restore negative pressure

- drain the collection of fluid

53
Q

Where are chest tubes normally inserted?

A
  • upper anterior thorax for pneumothorax

- lower lateral chest wall for fluid

54
Q

What is subcutaneous emphysema?

A

air in the subcutaneous tissue and can result from a poor seal to the chest tube

55
Q

what are some nursing responsibilities for chest tubes and drainage systems?

A
  • monitor/ maintain patency
  • assess vital signs
  • observe dressing q 4hrs
  • palpate around dressing site
  • assess pain level
  • encourage deep breathing
  • ensure chest tube secure
  • drainage system bellow chest level
  • check water seal level for fluid
56
Q

What do you do if the chest tube becomes disconnected?

A

reconnect immediately or submerge end in 2cm of sterile water

57
Q

what do you do if the chest tube is pulled out?

A

cover wound with sterile dressing that is not occlusive

NRSG 202 (11 decks)

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