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Terms in this set (102)
clean technique: involves procedures to reduce number, and spread of organisms.
gloves are applied last
procedures to eliminate ALL microorganisms (OR, LD)
how to dry
dry from cleanest (fingertips) to least clean (forearms)
Droplet nuclei smaller than 5um
requires: private room, negative pressure airflow, n95 respiratory mask
Droplet larger than 5 um
- pneumonia, diptheria, rubella, pertussis, mumps
Requires: private room or cohort clinets
outside of 3 feet: appropriate to walk into the room of client, without barrier equipment.
stem cell transplants
Requires: private room, positive airflow
Steps for removing PPE
1. Remove gloves.
2. Remove eyewear
3.Untie waist and neck strings of gown, allow gown to fall from shoulders.
d. Remove mask. First remove top mask strings.
e. perform hand hygiene.
Steps for putting on PPE
1. Apply gown.
2. Apply mask.
c. Apply googles.
d. Apply gloves last!
1. wash face
2. bath eye from inner to outer canthus
3. absolutely use gloves for peri area
A-Activate fire alarm
- Close all doors and windows
- Turn off oxygen
- Place wet towels at base of doors
Types of fire extinguishers
A- ordinary combustibles (wood, cloth)
B- flammable liquids
Immediately disengage electrical source, assess for presense of pulse.
Medications that increase risk for falls
Antidepressants, antihypertensives, NSAIDS, diuretics, antiparkinson drugs, antihistamines
Assess medical conditions: electrolyte disturbance, heart disease, excessive fatigue, alcohol use.
1. Guide client to floor and protect head. Turn client onto side, head slightly flexed forward.
2. Do not force oral airway
3. status epilepticus is a medical emergency, call physician. Insert oral airway when jaw is relaxed between seizure activity.
Most common single precuror to extremity amputations among diabetics?
clients who receive chemotherapy, radition, or nasogastric tube intubation, infection of mouth, vitamin B deficiency. inflammation of oral mucoasa.
avoid alcohol, stop smoking
Deep vein thrombosis. Blood clot that occurs in deep vein. Immobility increases risk. Use doppler or x-ray.
Symptoms: swelling, redness, one leg looks bigger than the other.
Most serious complication is when clot dislodges and travels to lungs causing pulmonary embolism.
all patients are considered to be possible carriers of blood-borne pathogens. The guideline recommends wearing gloves when collecting or handling blood and body fluids contaminated with blood, wearing face shields when there is danger of blood splashing on mucous membranes and disposing of all needles and sharp objects in puncture-resistant containers.
Clostridium Difficile. Gram positive bacteria, associated with antibiotic induced diarrhea. Often acquired nosocomially. New, highly toxic strain is resistant to many antibiotics, including Ciproflaxin.
Use contact isolation precautions
Methicillin resistant staphyloccocus. Use contact isolation precautions. MRSA is, by definition, any strain of Staphylococcus aureus bacteria that has developed resistance to beta-lactam antibiotics which include the penicillins (methicillin, dicloxacillin, nafcillin, oxacillin, etc.) and the cephalosporins
order in case of fire
1. move ambulatory clients first
2. move bedridden by wheelchair, bed, etc.
3. move those on life support.
Symptoms at time of fall
Location of fall
Activity at time of fal
Time of fall
Trauma post fall
Also use "get up and go test"- measures time it takes to rise from a standard chair, walk 3 meters, turn, walk back, sit down.
On what side to stand when ambulating a patient?
On their weaker side.
every 2 hours if confined to bed, every 30 minutes if confined to chair.
main expected outcome of movement: client's skin remains intact.
Best way to prevent DVT
if ambulation is not feasible, sequential compression devise, or elastic stocking works.
90 degrees (semi-fowlers is 45 to 60 degrees). Recommended for eating. Improve breathing by decreasing pressure of diaphragm.
30 degree lateral position
Removes pressure from bony prominences on back.
improves oxygenation in clients with severe pulmonary problems, like adult respiratory distressed.
not advisable with patients with spinal, facial trauma, hip knee surgery, etc.
risk factors used in assessing client for thrombosis.
1. hypercoagulabilty (clotting disoders)
2. Venous wall abnormalities (varicose veins, artherosclerosis)
3. Blood stasis.
when not to use stockings
1. dermatitis or open skin lesions
2. recent skin graft
3. decreased circulation in lower extremities as evidenced by cyanotic cool extremities/ gangrenous conditions.
you need to obtain physician's order
walking with cane
1. Cane should be on the stronger side of the body.
2. Place cane forward, then place weak leg forward, even with cane.
3. Place stronger leg past cane.
client is able to perform ROM independently
exercises performed for the client by the caregiver.
Support joint by holding distal and proximal areas adjacent to joint. Use cupped had to support joint. Go from head, to toe.
1. assist with toileting
2. assist with hand washing, and face/oral care.
3. set up environment for breaky
four point gait
offers most support, because it provides at least three points of support at all times. Requires weight bearing on both legs.
three point gait
requires client to beat all weight on one goot. weight is born in healthy leg, affected leg does not touch ground during early phase.
two point gait
requires at least partial weight bearing on each foot. is faster than four point gait. requires more balance because only two points support body at one time.
Used by clients whose lower extreities are paralyzed.
persons who show no symptoms of illness but hwo have pathogens on or in their bodies that can be transferred
the 8 risk factors in the Heindrich fall assessment
• confusion, disorientation, impulsivity
• symptomatic depression
• altered elimination
• dizziness, vertigo
• male sex
• administration of antiepileptics (or dosage
changes or cessation)
• administration of benzodiazepines
• poor performance in the "Get-Up-and-Go" test
of rising from a seated position
these are considered as restraints:
Examples from the Interpretive Guidelines (§482.13(e)(1)(i)(A-C) include waist, vest, wrist or leg restraints, hand mitts, chairs with tabletops, full siderails, 'net beds' or 'enclosed beds', 'freedom' elbow splints, or tucking a patient's sheets so tightly that the patient cannot move
an alternative to IV
Heplock. The device is referred to as a hep lock because a medication called heparin or a similar blood thinner is injected to flush the site and keep the vein open by stopping a clot from forming. Medication can be administered through a lock injection directly with a syringe or by hooking up IV to the catheter
Falls among older adults are not a normal consequence of aging; rather, they are considered a ________
an unexpected occurrence involving death, serious injury, or risk thereof. any process variation (med administration, restraint application procedures for which a reccurance would carry a significant chance of a serious adverse outcome.
the use of restraints is associated with these complications
if client is in bed during seizure
turn client to side and raise side rails
Most frequently occuring chronic conditions:
stochastic theory of aging
aging as result of random cellular damage that occurs over time. Accumulated damage leads to the physical changes that we recognize as characteristic of the aging process.
nonstochastic theory of aging
genetically programmed physiological mechniasm within the body control the process of aging
older adult presentation of uti
confusion, incontinence, falls, instead of fever, dysuria, frequency or urgency
older adult presentation of myocardial infarction
dyspnea (shortness of breath), confusion instead of crushing chest pain and diaphoresis (excessive sweating).
older adult presentation of pneumonia
tachypnea, tachycardia, and confusion with decreased appetite instead of productive cough
drug toxicity is most often linked to ______
mental status changes
decrease in appetite is a common symptom in adults with _____
pneumonia, UTI, heart failure
early indications of acute illness in adults
falls, dehydration, decrease in appetite, loss of function, dizziness, and incontinence
dizziness is a commonly occuring sign of these illnesses
anemia, arrhythmia, infection, myocardial infarction, stroke, brain tumor
aging does not inevitably lead to _______
independence and disability. Most elders remain funtionally independent despite the increasing prevalence of disease.
branch of medicine dealing with the diagnosis and treatment of disease and problems affecting older adults
the study of all aspects of the aging process
infection occurs in a cycle that depends on the presence of all of these following elements
1. an infection agent/pathogen
2. a reservoir
3. a portal of exit
4. a mode of transmission
5. a portal of entry to a host
6. a susceptible host
if hands are visibly soiled ____
use soap and water
the most common reservoir is _____
the human body
Risks for infection with older adults
Age related decline in immune function is termed "immune senescence"
older adults are less capable of producing lymphocytes.
more likely to produces autoantibodies
Many elderly can have an advanced infection without it being identified due to:
- reduced inflammatory response
- increased fatigue, diminished pain response
- chronic use of aspirin, NSAIDs
standard precautions apply to contact with blood, body fluid, nonintact skin, and mucus membrane
do hand hygiene in all of these situations
after contact with client's intact skin (such as taking pulse, or BP)
after contact with fluids or excretions
when moving from a contaminated body site to a clean body site
after contact with inanimate objeted in the immediate area of client
before caring for clients that are immunosuppressed
before inserted invasive devices
affter removing cloves
dry from the fingertips (the cleanest) to the least clean (forearms)
difference between disinfection and sterilization
disinfection is a process that eliminates many microorganisms with the exception of bacterial spores.
sterilization is the complete elimination or destruction of all microorganism, including spores. (steam, ethylene oxide). Critical items must be sterile- surgical instruments, catheters, implants. These items enter sterile tissue.
semicritical items must be high level disinfected, or sterilized: endoscopes, endotracheal tubes, gastrointestinal endoscopes, diaphragm fitting rings these items come into contact with mucus membranes
contact tramission: direct, and indirect
direct contact transmission is applied to the care and handling of contaminated body fluids directly, through contact with compromised skin.
indirect transmission involves the transfer of an agent thruog ha contaminated intermediate object, like hands of the worker, or instrument.
contact precautions are to be used with clients
+ C Diff
+ clostridium difficile
+ non contained secretory wounds
surgical technique is used for:
insertion of IV catheters, or central lines, insertion of IVs or catheters into sterile body cavities, like the insertion of the urinary catheter.
rules of surgical asepsis
1. a sterile object remains sterile only when touched by another sterile object.
a. sterile gloves are used to handle objects on a sterile field.
b.sterile touching clean becomes contaminated
2. a sterile object or field out of the range of vision or an object held below a persons waist is contaminated. never turn your back on the SF.
3. a sterile field becomes contaminated by prolonged exposure to air
4. any exposure to moisture/spill is source of contamination.
5. The one inch border around the sterile field is contaminated.
joints that are not moved periodically are at risk for
contractures, a permanent shortening of a muscle followed by the eventual shortening of associated ligaments and tendoms. The joint becomes fixed in one posiiton.
if client begins to fall:
1. assume wide base of support
2. extend one leg and allow client to slide against it to the floor.
3. bend knees to lower body as client slides to the floor, protect client's head.
crutch walking on stairs
ascending stairs: use a modified three point gait.
1. healthy leg is moved up first
going down stairs:
1. place crutches on stairs
2. move affected leg forward
3. move healthy leg forward
the basic crutch stance is _____
the tripod position. this provides a wide base of support.
crutches are placed 15 cm in front, and 15 cm to the side of the feet.
the axillae should not bear any weight
client assumes tripod position before any crutch walking.
these specific diseases especially benefit from exercise:
1. coronary heart disease
2. hypertension (aerobic exercise)
3. chronic obstructive pulmonary disease
4. diabetes mellitus
Risk factors for oral hygiene:
radiation therapy to head and neck
+prone to dry mouth, gingivitis, periodontal disease, loss of teeth.
+end up killing normal cells lining oral cavity. ulcers and inflammation.
+reduces salivary flow and lowers saliva pH. leads to stomatitis and tooth decay
+ventilator associated pneumonia. use of chlorhexidine reduces the risk of VAP.
"am care" refers to
1. offering bed pan
2. washing hands and face
3. assisting with oral care
this is done BEFORE breakfast
"complete am care" refers to
1. offer bedpan/urinal
3. peri care
4. foot/nail/hair care
5. back rub
6. changing gown
7. changing bed linenp
clients most in need of peri care are _____
those at risk for aquiring an infection (clients with catheters, genital surgery, childbirth, women)
signs of peripheral neuropathy
muscle wasting of lower extremities
absense of deep tendon reflexes
decreased hair growth on legs and feet
absent of decreased pulses
infection in foot
poor wound healing
blanching of skin on elevation
clients who receive chemo, radiation, or nasogastric tube intubation often suffer from
defined as the absence of disease producing (pathogenic) organism that involves the purposeful transfer of microorganism.
fundamental to standard precautions is ____
the use of barrier protection, or PPE
____ is still believed to be the most imporatant and effective infection control measure
antimicrobial hand washes often have _____ effects
when to WASH hands
1. visibly soiled
2. before and after eating
3. after using restroom
4. exposed to spore forming bacteria
if a client is sitting in chair, how often to reposition?
every 30 minutes
how many fingers should fit between axilla and crutches
2 to 3 (4 to 5 cm)
during seizure, keep client in _____ position
with contact isolation wear
gown and gloves
Components of critical thinking
K- Knowledge base
Levels of critical thinking
Fulmer SPICES is a framework for assessing older adults that focuses on six common "marker conditions": sleep problems, problems with eating and feeding, incontinence, confusion, evidence of falls, and skin breakdown. These conditions provide a snapshot of a patient's overall health and the quality of care.
it is an alert system
phenomenon of rapid decline resulting from 1. frailty, 2. acute illness, stress 3. institutional care, usually acute hospitalization
Get a 1 on the fall risk scale.
used for anxiety, sedation, sleep
can really lead to confusion in the eldery
patient centered care
patient has full control of the care they receive.
patient focused care
patients are the focus of care, but healthcare providers have final say in implimintation
found with blood tests
great indicator of nutrition (affected by hydration)
1. albumin 3.5-5.5
pre albumin 15-25 mg/dL
best but is more expensive
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