Study Guide Exam 4 Ch 7, 14, & 22 - Fall 2019 PDF

Preview

Summary

basic nursing skills ...

Description

Basic Skills

Study Guide Exam 4 – Chapters 7, 14, & 22 Fall 2019 Chapter 7: Asepsis and Infection Control 1. Explain the difference between sterile technique and aseptic technique.  Sterile Technique: o Surgical Technique o Destroy all microorganisms and their spores o Used in specialized areas, such as the operating room, or during invasive procedures, such as urinary catheter insertion  Aseptic Technique: o Medical Technique/ or Clean Technique o Inhibit the growth and transmission of pathogenic micro-organisms o Used in many daily activities, such as hand hygiene and changing of patient bed linens 2. Know & understand the procedures for performing aseptic technique.  Disinfection: o The use of a chemical that can be applied to objects to destroy microorganisms o Does NOT destroy spores  Cleaning: o The removal of foreign materials, such as soil and organic material, from objects  Antiseptic: o A substance that tends to inhibit the growth and reproduction of microorganisms and may be used on humans o Also known as bacteriostatic solution o alcohol or chlorhexidine gluconate  Sterilization: o Methods used to kill all microorganisms, including spores  Methods of Sterilization and Disinfection o Steam under pressure, or moist heat o Boiling water is the best method for home use o Radiation is used to sterilize pharmaceutical goods o Dry heat is a method used for disinfecting  2 hours at 320°F (160°C) or for 45 minutes at 350°F (176.7°C) o Chemical solutions often are used to disinfect instruments because they are effective in destroying microorganisms

3. Discuss the body’s line of defense.

4. Discuss the Chain of Infection.  Infectious agent: o A pathogen o Pathogens can be bacteria, viruses, yeasts, fungi, and protozoa o Unwashed hands, wound drainage, soiled linen, and decaying teeth provide ideal areas for pathogenic growth o BACTERIA:  Aerobic bacteria: grow only in the presence of oxygen  Anaerobic bacteria: grow only in the absence of oxygen  Spore:  Formed by the bacterium when conditions are unfavorable for growth of the bacterium  Remains dormant until environmental conditions become favorable for growth  High degree of resistance to heat and disinfectants  Identification of the specific organism is vital to the development of the appropriate plan of treatment  Culture & Sensitivity Test:  Collected specimen is placed in a sterile container  Results assist the practitioner in determining which antimicrobial (antibiotic) medication will inhibit the pathogens’ growth effectively  Take 48 to 72 hours to complete

 







Streptococcus bacterium: responsible for more diseases than any other organism Methicillin-resistant Staphylococcus aureus (MRSA): multidrug resistant; hard to treat  Bacillus anthracis: causes the acute infectious disease of anthrax  B. anthracis spores can live in the soil for many years  Most likely routes of infection are inhalation of the spores and spore contact with skin  Treatment consists of antibiotics such as ciprofloxacin (Cipro) or doxycycline (Vibramycin) o VIRUS  Composed of either RNA or DNA  Gain entrance to the body through various portals such as the respiratory tract, the gastrointestinal tract, and broken skin  Can infect a susceptible host through a mosquito bite or during an accidental needlestick with a contaminated needle  Viral infections are self-limiting; they run a given course, and usually recover  Antibiotics don’t/can’t treat a virus o FUNGI  Mycotic infections: diseases caused by yeasts and molds  Example of fungi is ringworm o PROTAZOA  Parasitic forms of protozoa are found in the intestinal tract, the genitourinary tract, the respiratory tract, and the circulatory system  Responsible for malaria, amebic dysentery, and African sleeping sickness Reservoir: o Where the pathogen can grow  Any natural habitat of a microorganism that promotes growth and reproduction o Characteristics of an environment that supports organism growth include an available food source, oxygen, water, light, and desirable temperatures and levels of acidity or alkalinity o Carrier/Vector: person or animal that doesn’t become ill but harbors/spreads organism, causing disease Portal of exit (exit route): o Exit route from the reservoir  Body fluids produced from the patient, such as those from the gastrointestinal, respiratory, and genitourinary systems or from an open area on the patient’s body Mode (method) of transmission: o Method or vehicle of transportation, such as exudate, feces, air droplets, hands, and needles o Vehicle:  means by which micro-organisms are carried about and transported to the next host, once they have left the reservoir o Contamination:  A condition of being soiled, stained, touched by, or otherwise exposed to harmful agents o A living organism is considered a vector  Mosquito o A non-living organism is considered a fomite  Inanimate object such as a doorknob o Indirect Method of Transmission  Vectors and fomites





o Direct Method of Transmission  Poor hand hygiene o Do not shake the linens when making a bed Portal of entry (entrance): o Entrance through skin, mucous lining, or mouth o If the patient’s skin is punctured with a contaminated needle, microorganisms are able to enter into the bloodstream. o If the nurse is not careful when changing a wound dressing, contamination of the new dressing or the wound Host: o Another person or animal that is susceptible to the pathogen o Immunizations have proven effective in reducing susceptibility to some types of infectious diseases

5. How to break the chain of infection  BATHING o Use soap and water to remove drainage, dried secretions, excess perspiration, or sediment from disinfectants.  DRESSING CHANGES o Change wet or soiled dressings.  CONTAMINATED ARTICLES o Place used tissues, soiled dressings, and soiled linen in moisture-resistant bags for proper disposal. o Place dressings that can be poured, dripped, or squeezed in biohazard bags.  CONTAMINATED NEEDLES AND SHARPS

 





o Place syringes uncapped hypodermic needles, and sharps such as scalpels in moistureresistant, puncture-proof containers (often called “sharps containers”). o Keep these in patients’ rooms or treatment areas so that carrying exposed, contaminated equipment any distance is not necessary. o Do not recap needles or attempt to break them. BEDSIDE UNIT o Keep table surfaces clean and dry. BOTTLED SOLUTIONS o Do not leave bottled solutions open for prolonged periods. o Keep solutions tightly capped. o Date bottles when opened. o Use only as directed by the manufacturer. SURGICAL WOUNDS o Maintain the patency of drainage tubes and collection bags to prevent accumulation of serous fluid under the skin surface. DRAINAGE BOTTLES AND BAGS o Empty and dispose of drainage suction canisters according to agency policy. o Empty all drainage systems on each shift unless otherwise ordered by a physician. o Never raise a drainage system (e.g., urinary drainage bag) above the level of the site being drained unless it is clamped off

6. Explain & discuss procedures for managing sterile packages, preparing a sterile field, & Pouring sterile solutions.  Managing Sterile Packages: o Sterile items should be placed in clean enclosed storage cabinets and never kept in the same room as dirty equipment o Sterile supplies have dated labels or chemical tapes that indicate the date when the sterilization expires o Tapes change color during sterilization process; if no color change the item’s not sterile o Never use or allow use of a sterile item or piece of equipment after the expiration date o If the nurse finds moisture present after a sterile tray is opened, the item is discarded o Before opening a sterile item, perform thorough hand hygiene o Sterile packaged items can be opened without contamination of the contents even when you are not wearing sterile gloves o Open package away from your body o Drop equipment in center of sterile field o Do not allow equipment to touch 1-inch unsterile border  Preparing a Sterile Field: o The nurse should prepare the field by using the inner surface of a sterile wrapper as the work surface or by using a sterile drape o Do not touch the center of the sterile field, only the 1-inch border  Pouring Sterile Solutions: o The bottle’s neck is contaminated, but the inside of the bottle cap is sterile o Never allow a bottle’s cap to rest sterile side down on a sterile surface because the cap’s outer edge is unsterile o Hold the bottle with its label in the palm of the hand to prevent the solution from wetting the label

7. Discuss Isolation techniques and understand any necessary nursing interventions for each.  Airborne Precautions: o For patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei o Keep door closed when not required for entry and exit o Patient must wear a surgical mask when being transferred outside of room o Examples:  Measles  Varicella zoster virus (including disseminated zoster), responsible for chickenpox and shingles  Tuberculosis  Airborne precautions should be practiced for all patients with known or suspected TB.  Respiratory symptoms that last longer than 2 weeks • Fatigue, unexplained weight loss, dyspnea, fever, night sweats, and hemoptysis (a cough that can be productive of blood)  Isolation is mandatory in a single-patient room designated as negative-pressure airflow  Mandatory that health care workers wear an N-95  Droplet Precautions: o For patients known or suspected to have serious illness transmitted by large particle droplets o Examples:  Invasive Haemophilus influenzae, including meningitis, pneumonia, epiglottitis, and sepsis  Invasive Neisseria meningitidis disease, including meningitis, pneumonia, and sepsis Examples of other serious bacterial respiratory infections  Diphtheria (pharyngeal)  Mycoplasma pneumonia  Pertussis  Pneumonic plague  Streptococcal pharyngitis, pneumonia, and scarlet fever  Adenovirus  Influenza  Mumps  Parvovirus B19  Rubella  Contact Precautions: o Easily transmitted by direct patient contact or by contact with items in the patient’s environment. o Examples:  Gastrointestinal, respiratory, skin, or wound infections or colonization with multidrug-resistant bacteria  Enteric infections  Clostridium difficile  Diapered or incontinent patients • Escherichia coli O157:H7 • Shigella



• Hepatitis A • Rotavirus  Respiratory syncytial virus, parainfluenza virus, and enteroviral infections in infants and young children  Skin infections that are highly contagious  Diphtheria (cutaneous)  Herpes simplex virus  Impetigo  Major (noncontaminated) abscesses, cellulitis, or decubitus ulcers  Pediculosis  Scabies  Staphylococcal furunculosis  Methicillin-resistant Staphylococcus aureus (MRSA)  Vancomycin-resistant enterococci (VRE)  Extended-spectrum beta-lactamase (ESBL)  Varicella zoster virus  Viral or hemorrhagic conjunctivitis  Viral hemorrhagic infections (Ebola, Lassa, Marburg) Immunocompromised Precautions: o Patient and all personal and family who are to enter the room must wear a mask and personal protective equipment. o Patient must have a private room

8. Know and understand the principles of sterile technique and the rationales.  Surgical asepsis is the complete removal of all microorganisms, including spores, from an object.  Surgical asepsis requires exact techniques  Instruct the patient how to avoid contaminating sterile items o The patient should try not to make sudden movements of body parts covered by sterile drapes. o The patient should refrain from touching sterile supplies, drapes, and the nurse’s gloves and gown. o The patient should avoid coughing, sneezing, or talking over a sterile area  Principles of Sterile Technique: o Sterile object remains sterile only when touched exclusively by other sterile objects o Sterile touching sterile remains sterile  Wear sterile gloves and use sterile forceps o Sterile touching clean becomes contaminated  Sterile object touches the surface of a clean disposable glove o Sterile touching contaminated becomes contaminated  When you touch a sterile object with an ungloved hand o Sterile touching questionable is contaminated  When you find a tear or break in the covering of a sterile object, discard the object o Place only sterile objects on a sterile field. o A sterile field out of the range of vision or an object held below a person’s waist is contaminated.  Never turn your back on a sterile field or leave it unattended o A sterile object or field becomes contaminated by prolonged exposure to air



Be sure no one talks, laughs, sneezes, or coughs over a sterile field or when gathering and using sterile equipment o When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated.  When stored sterile packages become wet, discard the objects immediately or resterilize o Fluid flows in the direction of gravity  To prevent contamination during a surgical hand scrub, raise and hold your hands above your elbows o Consider the edges of a sterile field or container to be contaminated  1-in (2.5-cm) border around the drape must be considered contaminated 9. Key Terms  Microorganisms: o tiny, usually microscopic, entities capable of carrying on living processes  Infection prevention and control: o Implementation of policies and procedures in hospitals and other health care facilities to minimize the spread of health care–associated or community-acquired infections to patients and other staff members  Health care–associated or community-acquired infections: o Infections or illness acquired from the healthcare facility after a 24-hour period  Asepsis: o The absence of pathogenic microorganisms  Localized Infection: o EX: a superficial wound infection  Systemic Infection: o An infection that affects the entire body instead of just a single organ or part

Chapter 14: Oxygenation 1. Know and understand oxygen therapy.  One method of preventing or relieving tissue hypoxia (reduced oxygen content in tissues and cells)  Must be ordered by a health care provider and closely monitored by the nurse to ensure proper administration  Oxygen is treated as a drug; therefore, it is important to follow the six rights of drug administration  The flow rate of oxygen is ordered in liters per minute (L/min)  Oxygen therapy may be initiated by a respiratory therapist, a nurse, an emergency medical technician (EMT), or any other licensed health care provider with an appropriate order for the oxygen 2. Discuss Signs & Symptoms of Hypoxia. Apprehension , anxiety, restlessness

Behavioral changes

Cardiac dysrhythmias

Cyanosis

↓ ability to concentrate

↓ level of consciousness

Dyspnea

Elevated B/P

↑ fatigue

↑ pulse rate

↑ rate & depth of resp.

Pallor

Digital clubbing (w/ chronic hypoxia) Vertigo

3. Discuss trach suctioning and the rationales.  Position patient in semi-Fowler’s position  Provide paper and pencil or a communication board for patient  Auscultate lung sounds  Preoxygenate patient by having patient take several deep breaths, by setting ventilator to deliver 100% oxygen with sigh breaths  Suction tracheal cannula  Apply intermittent suction by placing thumb on and off suction control, and gently rotate catheter as it is withdrawn.  Suction for a maximum of 10 seconds  Allow patient to rest between each suctioning effort.  Suction is performed as often as necessary, possibly every 5 minutes during the first few postoperative hours  The task of oropharyngeal suctioning can be delegated to unlicensed assistive personnel (UAP), including the patient and family when appropriate. o Gently insert Yankauer or tonsillar tip suction catheter into one side of mouth and glide it toward oropharynx without suction  The task of performing a permanent tracheostomy tube suctioning can be delegated to UAP  Common vacuum settings for wall suction units: o (1) Infants: 60 to 80 mm Hg o (2) Children: 100 to 120 mm Hg o (3) Adults: 120 to 150 mm Hg  Common catheter sizes: o (1) Infant: 6-Fr to 8-Fr o (2) Children: 10-Fr to 12-Fr o (3) Adults: 12-Fr to 14-Fr 4. Explain the rationales behind the use of cuffed tracheostomies by physicians and related nursing interventions.  The nurse is responsible for evaluating the patient’s airway patency (openness) and response to airway suctioning  Maintaining Nutritional Levels: o Patients with ET tubes are allowed nothing by mouth (NPO). o If a patient is able to eat, a cuffless tracheostomy tube is best o The patient may have a tracheostomy tube with a cuff to provide maximum sealing of the airway. o Cuffed tracheostomy tubes:  Used for patients who are at risk for aspiration because of swallowing difficulties or who are receiving mechanical ventilation.  Clean the diaphragm of the stethoscope and position the stethoscope in sternal notch or above tracheostomy tube  Listen for minimal amount of air leak at end of inspiration  Require mechanical ventilation  Ensure adequate ventilation and oxygenation o Listen to lung sounds regularly. o Elevate the head of the bed to assist with ventilation o Turn and reposition the patient every 2 hours for maximal ventilation and lung expansion.



o Evaluate the effects of respiratory therapy regularly. Provide Safety and Comfort o Check tube placement at regular intervals; tracheostomy tubes are secured around the neck with tapes or specially designed ties/strap. Make sure they are snug and the tube is securely in the neck stoma. o Change the tapes or ties/strap whenever they are soiled to lessen the chances of skin impairment. o Always keep a spare tracheostomy tube at the bedside

5. Discuss Endotracheal Tubes.  Tube inserted through the patient’s mouth and into the upper airway to provide a patent airway.  ET tubes are used for short-term management of the airway  Changed if needed for more than 2 weeks 6. Know and understand patient teaching of a patient on oxygen therapy and safety precautions to teach patients who use oxygen.  Patient Teaching: o Teach the patient to maintain adequate fluid intake to help liquefy secretions. o Recommend fluids that are free of caffeine and sugar because drinks high in caffeine and sugar sometimes cause dehydration. o Teach the patient to avoid dairy products, which tend to thicken secretions o Instruct patient and family members to fill plastic humidifier bottle with distilled water every 24 hours  Safety Precautions: o Educate the patient that smoking, wool blankets, and friction toys should be avoided when oxygen is administered o Avoid use of petrolatum products such as petroleum jelly o Secure portable oxygen delivery systems o Avoid placing oxygen cylinders near sources of heat, such as lamps or radiators. o Avoid clothing that is not fire resistant o Have three-prong outlets o Avoid frayed, tangled, or cluttered cords, and do not overload circuits 7. Explain lifespan considerations for older adults on Oxygen therapy.  Oxygen between 80- and 85-mm Hg (normal range is 80 to 100 mm Hg)  The respiratory drive normally is initiated by arterial carbon dioxide (PaCO2 ) levels rising, but in patients with chronic obstructive pulmonary disease (COPD), hypoxia tends to be the driving force behind respiratory effort (hypoxic drive).  If the hypoxia is corrected in a patient with COPD, then the respiratory drive is reduced, and respiratory difficulty will occur  Oxygen flow rates greater than 2 L/min are to be given with great caution in these individuals.  Flow rates higher than 2 L/min could eliminate the respiratory drive, and breathing may stop 8. Discuss nursing care of patients with tracheostomies.  Primary nursing responsibilities for maintaining a tracheostomy tube: o keep the airway clear o keep the inner cannula clean o prevent impairment of surrounding tissue

o provide the...