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Clin Lab 8/25/16 ppt
Infection Prevention and Control
| Question | Answer |
|---|---|
| What are the six parts of the Chain of Infection ? (Isaac reserves poor monkey's pie half) | 1. Infectious Agent or Pathogen 2. Reservoir or source for pathogen growth 3. Portal of exit 4. Mode of Transmission (airborn or contact) 5. Portal of Entry (how it enters) 6. Susceptible Host |
| What are the four stages of Infectious Process | 1. incubation period-can be infectious to other people-incubation produces illness commonly 2. Prodromal Stage 3. illness Stage 4. Convalescence |
| What is the definition of infection? | the invasion of a susceptible host by pathogens or microorganisms,; results in disease. |
| What is the definition of colonization? | the presence and growth of microorganisms within a host without tissue invasion or damage |
| What is the definition of a Communicable disease? | the infectious process transmitted from one person to another |
| What is the definition of Symptomatic? | clinical signs and symptoms are present |
| What is the definition of Asymptomatic? | clinical signs and symptoms are not present |
| A patient is admitted to a medical unit for a home-acquired pressure ulcer (wound where skin is not intact). The patient has Alzheimer's disease (memory loss) and has been incontinent of urine. The nurse inserts a Foley catheter. You will identify a link in the infection chain as: a. restraints b. poor hygiene c. Foley catheter bag d. improper positioning | Answer: C. Foley Catheter Bag. needs a sterile technique could cause infection |
| What are Normal Flora? (in regards to a body's defenses against infection) | Microorganisms that maintain a sensitive balance with other microorganisms to prevent infection. Any factor that disrupts this balance places a person at increased risk for acquiring a disease. |
| What body system defenses help defend against infection? | Organs |
| Why does Thrush happen? | b/c of them killing off normal flora... b/c antibiotics |
| Can you inflammation alone? | Yes. |
| Are signs of local inflammation and infection identical? | Yes. |
| Are vascular and cellular responses a part of inflammation? | Yes. |
| What are Exudates regarding inflammation? | serous, sanguineous, or purulent (drainage) |
| Describe serous in regards to inflammation? | straw color blister and yellow |
| Describe sanguineous in regards to inflammation? | bloody |
| Describe purulent in regards to inflammation? | cottage chees, chunky, cloudy |
| Does Tissue repair occur as a part of inflammation? | Yes. |
| Why does a person swell? | Swelling is the result of inflammation or a build-up of fluid |
| What are HAIs? | Health Care-Associated Infections |
| Hw do Health Care-Associated Infections (HAIs) result? | HAIs result from deliver of health services in a health care facility |
| Which Patients are at a greater risk for health care-associated infections (HAIs)? | Patients with multiple illnesses; older adults; poorly nourished patients (decrease in weight of patient); and patients with compromised immune systems (HIV, elderly, babies, chemo/radiation patients) |
| Can an obese patient be malnourished? | Yes. |
| What are the types of Health Care-associated Infections? (HAIs)? | 1. Iatrogenic-resulting from a procedure 2. Exogenous- outside 3. Endogenous-within |
| Mrs. Eldredge is a 63 year old woman who underwent a total hip replacement. A nursing student caring for Mrs. Eldredge on her home health clinical rotation. Two weeks after surgery, Mrs. Eldredge complains to the nursing student that she has increased pain in her hip and low-grade fever (by now Mrs. Eldrege should be feeling better after two weeks). The nursing student observes the incision and notes that it is red, swollen( edema), and warm? What should the nursing student do? | "triangle" in condition and notify physician. Mrs. Eldredge's wound was infected. She was admitted and received IV antibiotics and wound irrigation. She was discharged on day 4. At present the wound remains open, but it is healing with new granulation tissue that is healthy. |
| What is a "nosocomial" infection? | it is an infection acquired by the patient during medical care. An infection acquired by the patient during hospitalization. |
| DO older adults have an increased susceptibility to "nosocomial" infections? | Yes. |
| What are some sites for Health Care-associated Infections (HAIs) to occur? | 1. Urinary Tract (most common place) 2. Surgical or traumatic wounds (cannot control-swab) 3. Respiratory Tract 4. Bloodstream |
| What are factors influencing infection prevention and control? | 1. Age 2. Nutritional status 3. Stress 4. Disease Process 5. Treatments or conditions that compromise the immune response |
| What should a Nurse consider during an Assessment? | 1. See through the patient's eyes (subjective=says) 2. Status of defense mechanisms 3. Patient susceptibility-Medical Therapy 4. Clinical Appearance-Signs and symptoms of infection 5. Laboratory data-blood work increased WBC does not always mean infection (CBC-complete blood count) |
| The nurse s caring for a patient who underwent surgery 48 hours ago. On physical assessment, the nurse notices that the woulnd looks red and swollen. The patient's WBC's are elevated. The nurse should FIRST: a. Start antibiotics. b. Notify the physician. c. document the findings and reassess in two hours. d. Place the patient on isolation precautions. | B. Notify the physician. |
| In a Nursing Assessment what should be thoroughly investigated? | a. Defense mechanisms, susceptibility, and knowledge of how infections are transmitted b. review of systems, travel history c. Immunizations and vaccinations |
| Does a Nursing Assessment include an early recognition of risk factors? | Yes. |
| Does a Nursing Assessment include collecting data? | Yes. |
| What are the lab tests used to screen for Infection? | 1. White Blood Cell Count (WBC)-5000-10000 mm3-increase in infection 2. Erythrocyte Sedimentation Rate (Sed rate, ESR); increase inflammation/infectious process-up to 15 mm/hr in men and up to 20 mm/hr in women 3. Cultures of urine, bold, sputum, wound or throat-presence of infectious agent |
| What is the Nursing Process? (ADPIE) | 1. Assessment 2. Diagnosis-Nursing Diagnosis 3. Planning-What does the Nurse want to happen? 4. Implementation 5. Evaluation |
| What are some Nursing diagnoses for infection? | 1. risk of infection 2. imbalanced nutrition; less than body requirements 3. impaired oral mucous membrane 4. risk for impaired skin integrity 5. social isolation 6. impaired tissue integrity 7. readiness for enhanced immunization status |
| In the Planning stage of Nursing Process, what are you looking for: | goals and outcomes (what do I want to happen?) |
| What are some common goals of care applicable to patients with infection: | 1) preventing exposure to infectious organisms 2) controlling or reducing the extent of infection 3) maintaining resistance to infection 4) verbalizing understanding of infection prevention and control techniques (e.g. hand hygiene) |
| Do goals and outcomes in the Planning state of Nursing Process have to be specific, including specific measurements? for example 1 to 2 pounds to gain or lose for a patient) | Yes. |
| Case Study. Mrs. Eldredge continues recovering at home. When the nurse visits Mrs. Eldredge, the nurse teaches her about infection prevention and control practices. What are some infection prevention and control practices that the nurse can teach Mrs. Eldredge? | hand hygiene, triangle dressings, and triangle s/s of infection Educate the patient |
| What are the steps in cleaning object that is going to be used that has soil on it? | use protective eyewear and gloves 1) rinse contaminated object or article with cold running water to remove organic material 2) wash the object with soap and warm water 3) use a brush to remove dirt or material in grooves or seams 4) rinse the object in warm water 5) dry the object and prepare it for disinfection or sterilization if indicated 6) clean and dry cleaning equipment |
| What are two things that nurses should do in the Planning stage of the Nursing Process? | 1) Setting priorities-establish priorities for each diagnosis and for related goals of care 2) Teamwork and collaboration-remember to plan care and include other disciplines as necessary |
| What are three goals of the Implementation stage (putting the plan into action) of the Nursing Process? | 1) Health promotion-preventing an infection from developing or spreading 2) Acute care-treating an infectious process includes eliminating the infectious organisms and supporting the patient's defenses 3) intervention phase/doing where we are acting out our interventions |
| What is Asepsis? | the absence of pathogenic microorganisms |
| What is Medical Asepsis (clean technique)? | includes procedures used to REDUCE the number of an prevent the spread of microorganisms (ex. hand hygiene, barrier techniques, and environmental cleaning) |
| What is Surgical Asepsis (sterile technique)? | includes procedures used to ELIMINATE microorganisms from an area (ex. sterile instruments or equipment, esp. or suite, L&D) |
| What is Disinfection? | a process that eliminates many or all microorganisms, with the exception of bacterial spores, from inanimate objects (Ex. disinfection of surfaces, high-level disinfection, which is required for some items such as endoscopes) |
| What is Sterilization? | the complete ELIMINATION or destruction of ALL microorganisms, including spores |
| What is the most important and basic technique in preventing and controlling infection? | Hand Hygiene |
| What does Evidence-based Practice mean? | Doing something based on the research (for example, Nurses should NOT wear artificial nails) |
| How to conduct hand hygiene? | 15 seconds; wash-in and wash out; common sense |
| Is the task of hand hygiene preformed by all caregivers? | Yes. |
| Should a nurse teach and instruct hand hygiene? | Yes. |
| What does Gerontologic mean? | impact of infection is greater in older adults |
| How do you stop an infection from coming? | You break a link to prevent an infection from coming. |
| What can you do to practice patient safety in regards to infections? | 1) separate personal care items 2) handling exudate 3) wound cleaning 4) cough etiquette 5) dirty linen 6) maintain skin integrity (two hours) 7) perlneal care after toileting 8) urinary catheters and drainage sets 9) wound cleaning |
| What are the factors you consider as to whether you perform hand hygiene? | a) degree of contact b) amount of contamination c) susceptibility to infection d) procedure/activity to be performed |
| Is Hand Hygiene optional? | No. Hand Hygiene is not optional. |
| Quick Quiz. Health care works with chipped nail polish or long or artificial nails have high number so bacteria on their fingertips; therefore the CDC recommends: a. Using only neutral colored nonchip polish b. wearing gloves over artificial nails c. keeping natural nails less than 1/4 inch long d. allowing extra time for hand washing to scrub nails | c. keeping natural mails less than 1/4 inch long |
| Are alcohol-based hygiene products more effective than soap? | Yes. |
| Do alcohol-based hygiene products reduce infections? | Yes. |
| Do alcohol-based hygiene products with emollients, cause less skin irritation and dryness than soap? | Yes. |
| When is soap and water still necessary event though you have used an alcohol-based hygiene product for your hands? | When you have visibly soiled hands and when caring for patients with Clostridium difficile or multidrug-resistant organisms (MDROs) (examples lunch room or bathroom) |
| Quick Quiz: When hands are not visibly soiled or contaminated with blood or body fluids, the nurse may use an alcohol-based hand rub to perform hand hygiene. True or False? | True. |
| When caring for patients under isolation precautions, what things can you do? | 1.. use procedures to reduce cross-contamination to other patients 2. Use standard precautions (universal) 3. All body substances contain potentially infectious organisms 4. Use recommended isolation precautions |
| Quick Quiz: A nursing assistive personnel (NAP) arrives to assist the nurse with a dressing change by opening sterile packages. The NAP states that she doe snot need to peform hand hygiene before assisting the nurse because she is not going to touch the patient. Is the NAP correct? | No. With any type of interaction with a patient you should wash your hands. |
| What is isolation? | Isolation is the separation and restriction of movement of ill persons with contagious diseases |
| What types of isolation precautions are there? | 1. barrier precautions 2. standard precautions 3. isolation precautions: airborne, droplet, contact, and protective environment |
| What is a universal precaution/standard precaution in caring for a patient under isolation precautions? | "If it is not yours, don't touch it!" |
| What is another standard precaution in caring for a patient under isolation precautions? | "Wash in Wash out" |
| What are some Tier 1 Standard Precautions when caring for a patient under isolation precautions? | 1. used for all patients, regardless of risk or presumed infection status 2. apply to blood, blood products, all body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes 3. hand hygiene is performed between patient contact, contact with blood or body fluid, after gloves are removed 4. gloves are worn when touching bood, body fluids, secrtions, excretions you can add things |
| What are some Tier2 Transmission-Based Precautions when caring for a patient under isolation precautions? | Use for care of patients who are known or suspected to be infected, or colonized, with microorganisms; transmitted by contact, droplet, or airborne route |
| What are droplet precautions? | -Use barrier protection (ie. private room or cohart, USE MASK when closer than 3 feet of patient Transmitted by large droplets during coughing, sneezing, talking, or during suctioning or bronchoscopy (ex streptococcal pharyngitis (infant/young children), scarlet fever, pertussis, mumps, meningococcal pneumonia, pneumonia plague |
| What are some examples of Tier 1 Standard Precautions? | a. Masks, eye protection, or face shield if splashing may occur b. gowns are worn if soiling is likely c. equipment is properly be cleaned, single items are discarded d. all sharp instruments and needles are discarded in a puncture resistant container |
| What are some examples of Contact Precautions? | -barrier protection such as private room or cohort patient (2 patients having same infectious disease), gowns, and gloves -transmitted by direct contact or environmental contact, -multi-drug resistant organisms (MDROs) (VRE, MRSA, c. difficile), herpes simplex, , cabbies, respiratory syncytial virus (RSV) |
| What are some examples of Airborne Precautions? | -Barrier Protection=private room, door closed at all times -negative airflow (six exchanges per hour) -respirator (mask worn by patient during transportation out of room) -air is changed every six hours -transmitted by small droplet nuclei )ex. measles, varicella (inc. zoster) TB, small pox) |
| What are some examples of Special Care Precautions? | Neutropenic/Protective -sever neutropenia (deficient)(absolute neutrophil count) less than 1000 or physician discretion -private room -hands are washed prior to patient contact -those with colds, influenza, or other infectious processes are restricted from the room -no live flowers or plants in the room -no raw vegetables, fruits, juices -eggs must be well cooked -GOWN, MASK, GLOVES USED |
| Should a nurse teach visitors of a patient to follow isolation precautions when visiting the patient? | Yes. |
| What occurs with young patients when isolation precautions are used? | -isolation causes a sense of separation from family and loss of control -give children simple explanations -let the child see your face before you apply the mask |
| What occurs with older patients when isolation precautions are used? | watch for signs of confusion or depression |
| What should you be concerned about with home care and isolation precautions? | be aware of potential sources of contamination |
| What should a nurse do when transporting patients under isolation precautions? | -notify department that the patient is in isolation prior to transport -leave room only for essential purposes -patient as well as nurse must wear masks for airborne or droplet precautions -equipment must be properly cleaned after patient returns to the room |
| What should a nurse instruct a NAP when caring for a patient on isolation precautions? | The nurse can instruct the NAP todo the following: -take special precautions as needed -take precautions about bringing equipment into the patient's room -be aware of high-risk factors for infection transmission |
| Can Multidrug-resistant organisms cause HAIs? | Yes. |
| What about MRSA (methicillin resistant Stophylococcus aureus)? | MRSA (methicillin resistant Stophylococcus aureus) increased mortality |
| What about VRE (vancomycin resistant Enterococcus( (bug)? | VRE: greater risk to immune-compromised and debilitated patients |
| What about C.difficle? | C.difficle: spore-forming and difficult to eliminate; can stay dormant for a long time |
| How does a nurse handle bagging trash, linen & specimens? | -single bag, if it is impervious and sturdy and is not contaminated on the outside -soiled linen should be placed in an impervious bag -double bagging is not recommended unless it is impossible to prevent contamination of the bag's outer surface |
| What does a nurse consider in the Evaluation stage of the Nursing Process? | -see through the patient's eyes; have the patient's expectations been met? -patient outcomes: measure the success of the infection control techniques; compare the patient's actual response with expected outcomes; if goals are not achieved, determine what steps must be taken -exposure issues |
| If a procedure is not documented by a nurse is the procedure considered done? | No. "Not documented=Not Done" |
| What should a nurse document in the Evaluation stage of the Nursing Process? | -document procedures performed and patient's response to social isolation. Also document any patient education performed and reinforced -document type of isolation in use and the microorganisms ( if known) |
| What is the Bathing & Personal Hygiene procedure for the Posterior side of a patient? | First the middle back (lotion/back rub) Second the lower back area (butt) |
| What is the Bathing & Personal Hygiene procedure for the Anterior side of a patient? | First the head arms to middle legs to middle peri last female -top to bottom clean to dirty |
| What about feet and nail care of patient? | |
| Does hair care promote good self image? | Yes. |
| What about oral care of patient? | prevents caries & plaque -CDC recommends comprehensive program of oropharyngeal cleaning & decontamination for patients at the highest risk of developing HA-pneumonia |
| What about eye, ear, and nose care of patient? | Watch for cerumen, drainage |
| What are some factors influencing hygiene of patient? | Social patterns-ehnic, social, & family influences on hygiene patterns Body image-its a person's subjective concept of their body appearance -health beliefs & motivation-motivation is the key factor to hygiene -personal preferences-dictate hygiene practices Socioeconomic status-influences the type & extent of hygiene practices used -cultural variables-people from diverse cultures practice different hygiene rituals |
| What does bathing and hygiene practices do? | -skin is the first defense and keeping skin intact is essential -bathing and hygiene increase circulation & helps maintain muscle tone & joint mobility -provides relaxation & comfort -promotes assessment of condition -facilitates conversation between nurse and patient |
| What are some factors effecting hygiene of patient? | 1. culture, values, & beliefs 2. environment (ex. privacy) 3. motivation (ex. depression 4. mental health 5. cognitive abilities 6. energy (ex. tired) 7. acute illness & surgery 8. pain (ex. medication) 9. neuromuscular function 10. sensory deficits |
| What are some cultural considerations in regards to bathing and hygiene? | -middle eastern & East Asian women avoid uncovering the lower torso & exposing the arms -Orthodox Jews, Amis, Hindus, & Muslims consider touching unrelated males & females taboo, Use gender congruent caregivers whenever possible -among Hindus & Muslims, their right and is for eating & praying & the left hand is for cleaning gender private areas -Chinese, Japanese, Koreans & Hindus consider the upper body cleaner than the lower body -Hindus consider it irreverent to show any negative noverbal communicati |
| Quick Quiz: A male nurse is preparing to help shampoo the hair of an Amish woman. The woman refuses the nurse's assistance. What action should the nurse take? a. Explain to the woman that this is the only time the nurse has to hel p her. b. Seek the assistance of a female nurse to put the patient more at ease. c. Enlist the help of family members, giving them the supplies needed to complete the care. d. Leave the patient alone; eventually she will need to cooperate with the male nurse | b. Seek the assistance of a female nurse to put the patient more at ease. |
| When a nurse is giving a back massage, should the nurse massage reddened areas, bony prominences of the patient's back? | No. |
| What a nurse gives a bath to a patient should the nurse cleanse from inner to outer canthus? | Yes. |
| How should a nurse schedule Hygiene Care? | -earlymorningshould be urinal bedpan, washing hands & face, oral care -morning (usually after breakfast)-elimination, bath or shower, pernal care, back massage, oral, nail & hair care -afternoon-elimination, washing hands and face, oral care, bed linens & repositioning prn -hour of sleep (HS)-elimination, washing hands & face, oral care, back massage, bed linens, straightening unit |
| What are types of cleansing baths? | bed-bathe patient in bed -tub-emerse patient in tub -sponge-bath patient with sponge |
| What are types of therapeutic baths? | -sitz -medicated-aveno |
| What type of shaver should a nurse use on a patient who is at risk of bleeding? | electric shaver |
Created by:
Megansensky