the methods & procedures used to create a sterile field.
an area considered free from living microorganisms
an item or environment free from living microorganisms
any item or environment that has not been sterilized, has come into contact with an item that is no longer considered sterile, has entered a field that is not sterile.
Resistance to microorganisms
Certain treatments w/ antimicrobials, corticosteroids, or other immunosuppressive agents
Break in the 1st line of defense mechanisms from surgery, anesthesia & catheters
Standard precautions require (7 steps)
2. Protective barrier between worker & potentially infectious materials.
3. Proper handling of soiled equipment & cleaning equipment
4. Routine cleaning/disinfection of equipment
5. Proper handling of linen
6. Proper use/disposal of sharps
7. Use of alternative devices for mouth to mouth resuscitation
Reduces risk of transmission of microorganisms from recognized & unrecognized sources of infection
designed to prevent transmission of microorganisms by these routes in hospitals. Isolation breaks the chain between the host, source and transmission. The two tiers of isolation precautions are 1. Standard precautions. 2. Transmission-based precautions. Standard precautions are designed for the care of ALL patients.
When do we wear proper protective clothing
If you are going to be in contact with blood, body secretions and excretions
Minimum protection is provided by _________________, maximum protection is provided by_______________.
5 Routes of Transmission
4. Common vehicle
The 3 types of transmission based precautions
Contact, droplet, airborne
Most important & frequent mode of nosocomial infection transmission
1. Direct-involves direct body surface contact & physical transfer of microorganisms. Example: turning or transferring a patient, bathing or performing direct patient care.
2. Indirect-involves contact of a susceptible host with a contaminated intermediate object. Example: reuse electrodes on > 1 patient, contaminated hands and not changing gloves between patients.
Generated from a source person primarily during coughing, sneezing, talking, and possibly during suctioning or wound care.
Droplets containing microorganisms are propelled and are deposited on a host's conjunctivae, nasal mucosa or mouth.
Droplets don't remain suspended in the air versus airborne transmission. Require the patient to be in a private room if possible. A mask must be worn as in standard precautions and when within 3 feet of the patient.
1. Airborne droplet nuclei—particle residue 5 µm or smaller in size. Evaporated droplets containing microorganisms that remain suspended in the air for long periods of time.
2. Dust particles—contains the infectious agent that are dispersed by air currents & inhaled by a susceptible host. The distance is dependent on environmental factors thus special air handling & ventilation are required.
What about cohort patient rooms? How are these patients transferred from their room to imaging?
rooms with more than one patient
Elements of Respiratory Hygiene
2. Posted signs
3. Source control measures
4. Hand hygiene after contact
5. Spatial separation (> 3 feet)
Single most important means of preventing spread of nosocomial infections
20 seconds with warm water
Backs of hands, wrists, between fingers, fingernails
Rinsed & dried while water is running. Turn off water with towel
Scrubbing prior to sterile field entry is 2-6 minutes
Define nosocomial infection
infections that have been caught or received from the hospital
8 Requirements of a Sterile Field
4 requirements for establishment
4 requirements for maintenance of a sterile field
Provide quantitative measures of cardiovascular & respiratory function
Normal Blood Pressure
Normal BP= Systolic120/80 Diastolic
Pre-hypertensive= sys is 120-139, dia. is 80-89
Stage 1 HTN= sys 140-159, dia is 90-99
Stage 2 HTN= sys at or > 160, dia at or > 100
Blood pressure refers to
the force the blood exerts against a vessel.
The pressure is highest in _________ and lower in the _________ and lowest in the __________.
arteries, capillaries, veins
Systolic pressure occurs ________________ whereas diastolic pressure occurs ________________.
sys. when the heart contract or pumps, dia. rests between beets
Baroreceptors (receptor for BP)
located in the carotid & aortic arch are responsible for monitoring BP to the brain & throughout the body by detecting a change in vessel wall stretch.
also located in the carotid & aortic arteries detect changes in oxygen, CO2 & 'd H+ ions
Factors that influence BP (6)
1. Blood volume
2. Elasticity of arteries
3. Cardiac output
6. Arm position
Sudden drop in BP that occurs when the patient moves to a standing or sitting posture. After inactivity & prolonged bed rest, expect it!
exhale forcibly with glottis, nose and moth closed. increases intrathoracic pressure results in decreased venous return and decreased blood pressure; when breath released, sudden decrease in intrathoracic pressure and increased venous return which causes increased HR and BP.
1- clear tapping sound = systolic BP
2- murmur or swishing sound
3- becomes crisp and louder
4- distinct, abrupt muffling= 1st diastolic BP
5- sounds disappear; 2nd diastolic BP
Adult is 60-90 bpm
Pulses are described by rate and rhythm: rate is the # of beats/minute and rhythm is the interval between beats.
Factors influencing pulse rate include:
Age, sex, emotional status, physical activity level, body size & build
High blood volume ='s a stronger pulse & a lower blood volume ='s a weaker pulse
Application of a cold pack has the potential to __________ vs application of a hot pack has the potential to ____________.
Physiology and purpose of pulse
measurement of HR
wave of blood in artery created by contraction of left ventricle
measure before, during and after intervention
-during: systems ability to provide blood flow
-after: recovery capability
presence or absence of pulse
arterial occlusion or peripheral vascular insufficiency
observe for trophic changes
sequelae of decreased circulation: loss of hair, dry skin, atrophy
-edema may interfere w/ ability to palpate
-blanching of skin; can look for capillary refill
Amplitude of pulse
absent (0), thready/weak (1+), normal (2+), strong (3+), full bounding (4+)
Normal for Adults is 12-20 bpm
Factors that Influence Respiration
Physical activity level
Body size & build
Explain & understand rate, rhythm, depth, and character of respirations
rate is the number of breaths a person takes in a minute, rhythm is the manner in which a person breaths, depth is the amplitude movement , character includes rhythm, depth, ease of breathing, and sounds
In people over 65, their respiratory rate
may be higher than normal due to decreased elasticity of the lungs
Normal is 98.6 +/- 1.8 F (37 centigrade)
Peripheral receptors sense rapid increase in temperature
Central receptors sense temperature increase in blood
What is pyrexia and how does it change each of the vital signs?
fever, high temperature
Factors Influencing Temperature
Time of day
Location of measurement
Ingestion of warm/cold foods/liquids
Whom is more susceptible to temperature changes; adults, children, elderly?
children and elderly. Elderly can have a lower temperature.
60 - 85 bpm (pulse)
less than 60 bpm
more than 100 bpm
slow breathing of less than 10 bpm (breaths)
rapid, shallow breathing of greater than 24 bpm (breaths)
rectal greater than 106
rectal less than 94
patient in respiratory distress, w/ increased sounds of respiration
These SIGNS are important indicators of the body's physiological status & reflect the function of internal organs