Week 2 - airborne, TB skin testing, trach, chest tubes Flashcards
what are airborne precautions used in addition to?
routine precautions to prevent transmission of airborne particles
what do airborne precautions prevent?
transmission of airborne particles that remain suspended in air that can be inhaled by others in the same/ different room, or ward
What does a nurse need to do/wear if someone is on airborne precautions?
- point of care risk assessment
- N95 respirator
What does a nurse need to do/wear if someone is on airborne & contact precautions?
- point of care risk assessment
- gown and gloves
- N95
describe an airborne particle
- organisms contained in droplet nuclei
- small airborne particles <5 microns in size
- result form evaporation of large droplets
where can airborne particles be contained?
debris in dust particles that remain suspended in air for long periods of time
what does control of airborne transmission require?
control of air flow through special ventilation systems and use of respirators
what are some specific aetiologies in regards to airborne?
- measles
- tuberculosis (pulmonary or laryngeal)
what are some specific aetiologies in regards to airborne/contact?
- monkey pox
- smallpox
- varicella zoster virus
What is an anteroom?
- clean area
- transition room to get people in/out of airborne isolation room
- located between hallway and patients room
what do healthcare works use the anteroom for?
don and doff their N95 masks for airborne isolation
What is an airborne isolation room?
single patient room equipped with special air handling (negative pressure) and ventilation
describe an airborne isolation room?
- 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
what does an airborne isolation room require the nurse to wear?
- N95 respirator that filters particles 1 micron in size
- have a 95% filter efficiency
- provide a face seal with <10% leak
What are some safety measures in regards to sharps?
- wash hands
- use appropriate equipment
- recap sterile unused needles using scoop technique
- use needle safety device to over used needle> never recap used needle
When should PPE be used in regards to sharps?
- possibility of exposure to blood, body fluids or secretions
What are some protocols for sharps?
- discard used needles in sharps container
- change sharps container/ notify appropriate personal when 2/3 full
- if needle injury occurs follow institutions guidelines
where does an intradermal injection go?
- into the dermis
- located between epidermis and subcutaneous tissue
What medications are administered through the intradermal route?
common ones:
- allergy testing
- TB Mantoux skin test
How much can an intradermal injection be?
small amount of liquid usually 0.1mL
what needle is used for an intradermal injections?
25-27 gauge syringe that has a 1/4-1/2 inch long safety needle
where is TB medication stores? How long do you have to us it?
- stored in fridge
- once punctured use within 30 days
- can be prepared my pharmacy > must be administered within 20 mins once received
after preparing your syringe with medication what do you. need to label it with?
- 2 client identifiers
- name of medication
- dose and amount
where are intradermal injections usually injected?
into the inner forearm away from any lesions or skin trauma
How do you inject an intradermal injection?
- 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
what happens if no wheal or bleb is formed or solution leaks out?
repeat test at least 2-4 inches away from initial test
in regards to TB what do you need to document on the MAR?
- date
- dose
- route
- lot #
- site location
- measure of the wheal/bleb
what do you need to document on the narrative notes for TB?
- how Client tolerated
- if there were any adverse reactions
What needs to be initiated for TB testing?
BCCDC screening form section 1 and 2
Who can read a TB skin test and when?
designated HCP 48-72hrs from administration of test
what is considered a negative TB skin test?
skin test of 0-4mm
what does the TB skin test not differentiate between?
active TB and latent TB infection
What should you palpate for when assessing a TB skin result?
induration using sweeping motion over area with your fingers
Where do you document the results of a TB skin test?
- MAR (signature/ measurement in mm not +/-)
- BCCDC TB screening form
how do you figure out the size of TB skin result?
- mark borders of induration laterally across arm
- measure area
Who is at a higher risk of developing TB?
- 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
If a person is a contact of an active TB case what should they be assessed for?
window period prophylaxis (WPP) regardless of initial TST result
What are some contraindications of repeating TB Mantoux skin test?
- prior allergic reaction
- previous positive TB skin test
- previous active TB blood test (IGRA)
- previous active TB disease/ latent tuberculosis
if repeating TB Mantoux skin test is contraindicated what other tests can be done?
CXR and/or sputum specimens for AFB (3 consecutive)
TB results are considered in contact with what other factors?
- results used to determine if further testing/ treatment needed
if TB results come back and person is negative what does this mean?
- 0mm reaction place completed TB screening in client’s chart
- if negative but client was a contact or has signs/ symptoms consider positive
if TB results come back and person is positive what does this mean?
- 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
What is a tracheostomy?
an opening for a tube via surgical incision in the trachea just below the larynx
What is the opening of a tracheostomy called?
stoma
What are the components of a tracheostomy tube?
- outer cannula with a flange
- inner canula
- obturator
when taking care of someone with a tracheostomy what do you need to assess?
- 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
When assessing the appearance of the incision in regards to someone with a tracheostomy what does this include?
- redness
- swelling
- purulent discharge
- odour
What can cause the need for a chest tube?
pressure placed on lungs that interferes with ling expansion due to:
- pneumothorax
- hemothorax
- pleural effusion
what is a pneumothorax ?
collection of air in the pleural space
what is a hemothorax?
collection of blood in the pleural space
what is a pleural effusion?
collection of fluid in the pleural space
Why are chest tubes inserted?
- restore negative pressure
- drain the collection of fluid
Where are chest tubes normally inserted?
- upper anterior thorax for pneumothorax
- lower lateral chest wall for fluid
What is subcutaneous emphysema?
air in the subcutaneous tissue and can result from a poor seal to the chest tube
what are some nursing responsibilities for chest tubes and drainage systems?
- 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
What do you do if the chest tube becomes disconnected?
reconnect immediately or submerge end in 2cm of sterile water
what do you do if the chest tube is pulled out?
cover wound with sterile dressing that is not occlusive
