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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
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
26
what happens if no wheal or bleb is formed or solution leaks out?
repeat test at least 2-4 inches away from initial test
27
in regards to TB what do you need to document on the MAR?
- date - dose - route - lot # - site location - measure of the wheal/bleb
28
what do you need to document on the narrative notes for TB?
- how Client tolerated | - if there were any adverse reactions
29
What needs to be initiated for TB testing?
BCCDC screening form section 1 and 2
30
Who can read a TB skin test and when?
designated HCP 48-72hrs from administration of test
31
what is considered a negative TB skin test?
skin test of 0-4mm
32
what does the TB skin test not differentiate between?
active TB and latent TB infection
33
What should you palpate for when assessing a TB skin result?
induration using sweeping motion over area with your fingers
34
Where do you document the results of a TB skin test?
- MAR (signature/ measurement in mm not +/-) | - BCCDC TB screening form
35
how do you figure out the size of TB skin result?
- mark borders of induration laterally across arm | - measure area
36
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
37
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
38
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
39
if repeating TB Mantoux skin test is contraindicated what other tests can be done?
CXR and/or sputum specimens for AFB (3 consecutive)
40
TB results are considered in contact with what other factors?
- results used to determine if further testing/ treatment needed
41
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
42
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
43
What is a tracheostomy?
an opening for a tube via surgical incision in the trachea just below the larynx
44
What is the opening of a tracheostomy called?
stoma
45
What are the components of a tracheostomy tube?
- outer cannula with a flange - inner canula - obturator
46
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
47
When assessing the appearance of the incision in regards to someone with a tracheostomy what does this include?
- redness - swelling - purulent discharge - odour
48
What can cause the need for a chest tube?
pressure placed on lungs that interferes with ling expansion due to: - pneumothorax - hemothorax - pleural effusion
49
what is a pneumothorax ?
collection of air in the pleural space
50
what is a hemothorax?
collection of blood in the pleural space
51
what is a pleural effusion?
collection of fluid in the pleural space
52
Why are chest tubes inserted?
- restore negative pressure | - drain the collection of fluid
53
Where are chest tubes normally inserted?
- upper anterior thorax for pneumothorax | - lower lateral chest wall for fluid
54
What is subcutaneous emphysema?
air in the subcutaneous tissue and can result from a poor seal to the chest tube
55
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
56
What do you do if the chest tube becomes disconnected?
reconnect immediately or submerge end in 2cm of sterile water
57
what do you do if the chest tube is pulled out?
cover wound with sterile dressing that is not occlusive

NRSG 202 (11 decks)

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