Pdf (19) - active learning template PDF

Preview

Summary

active learning template...

Description

ACTIVE LEARNING TEMPLATE:

Diagnostic Procedure

STUDENT NAME _____________________________________

Blood Cultures PROCEDURE NAME ____________________________________________________________________

REVIEW MODULE CHAPTER ___________

Description of Procedure A blood culture is performed to isolate and aid in the identification of the pathogens in bacteremia (bacterial invasion of the bloodstream) and septicemia (systemic spread of such infection). It requires inoculating a culture medium with a blood sample and in cubating it. Blood cultures can identify about 67% of pathogens within 24 hours and up to 90% within 72 hours.Bacteremia may be transient, intermittent, or continuous. The timing of sample collection for blood cultures varies; it usuall depends on the suspected type of bacteremia (intermittent or continuous) and on whether drug therapy needs to be started regardless of test results.

Indications 1. Clean venipuncture site with chlorhexidine frepp using back and forth friction scrub for 30 seconds. Allow it to dry for 30 seconds. 2. Do not retouch site; if you must repalpate for vein, the area must be recleaned using above procedure. Perform venipuncture. 3. When required amount of blood is received, remove needle from skin. 4. Hold pressure to site with gauze and apply adhesive bandage when bleeding stops. 5. Remove venipuncture needle from syringe and attach blunt fill needle and transfer device. 6. Remove tops of blood culture bottles and swab with chlorhexidine. 7. Inject blood specimens into bottles, place specimen into the anaerobic Orange bottle, then the aerobic Green bottle. If you only have enough blood for one bottle, place the specimen in the aerobic Green bottle. Be careful, the bottles are pressurized and will aspirate all of the blood from the syringe unless you control the flow with your thumb and index finger. Optimal blood amounts are necessary or you will have decreased sensitivity which may delay time to detection of a true positive blood culture. 8. Label bottle. Indicate whether line draw or peripheral. Label specimens with at least two patient identifiers, such as name, medical record number, and date of birth. 9. Discard needle and syringe into a sharps container. 10. Send specimen promptly to CCL. If the specimen is coming from the floors, send the audit trail with specimen that includes initials of person drawing the specimen, date, time and venipuncture site.

Interpretation of Findings Elevated Levels (Positive Cultures) • Mild, transient bacteremia infections • Infections due to Streptococcus pneumoniae and other Streptococcus species, Haemophilus influenzae, Staphylococcus aureus, Pseudomonas aeruginosa, Bacteroides, Brucella, Enterobacteriaceae, coliform bacilli, and Candida albicans • Staphylococcus epidermidis, diphtheroids, and Propionibacterium (in immunocompromised patients) • Mycobacterium tuberculosis and M. avium complex (in patients with human immunodeficiency virus infection)

Potential Complications excessive bleeding from the point of vein rupture infection fainting inflammation of the vein hematoma, or bruising light headedness

ACTIVE LEARNING TEMPLATES

CONSIDERATIONS

Nursing Interventions (pre, intra, post) • Confirm the patient’s identity using two patient identifiers according to facility policy. • Explain to the patient that the blood culture procedure is used to help identify the organism causing his symptoms. • Inform the patient that he doesn’t need to restrict food and fluids. • Advise the patient that he may experience slight discomfort from the tourniquet and needle punctures. • Put on gloves. • Clean the venipuncture site w/alcohol swab and then with an iodine swab, working in a circular motion from the site outward • Wait 1 min for the patient’s skin to dry, remove the residual iodine w/alcohol swab or remove the iodine after venipuncture. • Apply the tourniquet. • Perform a venipuncture; draw 10 to 20 mL of blood for an adult. • Clean the diaphragm tops of the culture bottles w/alcohol or iodine, and change the needle on the syringe. • If broth is used, add blood to each bottle until a 1:5 or 1:10 dilution is obtained. Exp. add 10 mL of blood to a 100-mL bottle • If a special resin is used, add blood to the resin in the bottles and invert them gently to mix. • If the lysis–centrifugation technique (Isolator) is used, draw the blood directly into a special collection and processing tube. • Indicate the tentative diagnosis on the laboratory request as well as current or recent antimicrobial therapy. • Send each sample to the laboratory immediately after collection. A • Apply direct pressure to the venipuncture site until bleeding stops. • Assess the venipuncture site for hematoma formation; if one develops, apply direct pressure. • Prepare to initiate antimicrobial therapy, as ordered.

Client Education -Inform pt if fasting is required -Explain Procedure and potential complications -notify pt when to expect results

Nursing Interventions • Institute appropriate infection control precautions as indicated by the causative organism. • Adhere to standard precautions at all times. • Expect to collect samples over the course of 2 consecutive days

THERAPEUTIC PROCEDURE

A3...