Infection Control Flashcards
Astle, B. J., & Duggleby, W. (2024). Canadian fundamentals of Nursing. Elsevier Inc. (244 cards)
1
Q
Patients in all health care settings are at risk for acquiring infections because they often have lower resistance to infectious microorganisms and increased exposure to numbers and types of disease-causing microorganisms, and they sometimes undergo ___ procedures wherein a body cavity or organ is entered by either puncture or incision.
(Astle & Duggleby, 2024, p. 677)
A
invasive
(Astle & Duggleby, 2024, p. 677)
2
Q
In acute care or ambulatory care facilities, patients can be exposed to pathogens, some of which may be ___ to most antibiotics.
(Astle & Duggleby, 2024, p. 677)
A
resistant
(Astle & Duggleby, 2024, p. 677)
3
Q
By practising ___ prevention and control techniques, nurses can avoid spreading microorganisms to patients.
(Astle & Duggleby, 2024, p. 677)
A
infection
(Astle & Duggleby, 2024, p. 677)
4
Q
Patient teaching should include information concerning infections, modes of ___, and methods of ___.
(Astle & Duggleby, 2024, p. 677)
A
transmission
prevention
(Astle & Duggleby, 2024, p. 677)
5
Q
Infection control has three purposes: (1) protecting ___ from acquiring infections, (2) protecting ___ ___ workers from becoming infected, and (3) protecting entire ___ from contracting infectious diseases.
(Astle & Duggleby, 2024, p. 677)
A
patients
health care
populations
(Astle & Duggleby, 2024, p. 677)
6
Q
___ are typically a single cell and can only be seen with the aid of a microscope.
They include bacteria, protozoa, certain types of algae, and fungi.
(Astle & Duggleby, 2024, p. 677)
A
Microorganisms
(Astle & Duggleby, 2024, p. 677)
7
Q
___ live and grow on inanimate objects and in air, water, food, soil, plants, and animals.
They also live and grow in and on people.
(Astle & Duggleby, 2024, p. 677)
A
Microorganisms
(Astle & Duggleby, 2024, p. 677)
8
Q
Most microorganisms are ___, meaning that they do not cause a person to be ill; however, some are ___, meaning that they can cause disease.
(Astle & Duggleby, 2024, p. 677)
A
nonpathogens
pathogens
(Astle & Duggleby, 2024, p. 677)
9
Q
An ___ is a disease state resulting from the entry and multiplication of a pathogen in the tissues of a host, causing the body to manifest clinical signs and symptoms.
(Astle & Duggleby, 2024, p. 677)
A
infection
(Astle & Duggleby, 2024, p. 677)
10
Q
If an infection can be transmitted from one person to another, it is a ___ (infectious, contagious) disease.
(Astle & Duggleby, 2024, p. 677)
A
communicable
(Astle & Duggleby, 2024, p. 677)
11
Q
Resident skin microorganisms are usually nonpathogenic.
However, they can cause serious infection when surgery or other invasive procedures allow them to enter deep tissues, or when a patient is severely ___ (has an impaired immune system).
(Astle & Duggleby, 2024, p. 677)
A
immunocompromised
(Astle & Duggleby, 2024, p. 677)
12
Q
The presence of a pathogen does not mean that an infection will begin.
An infection develops if the ___ of infection remains intact.
(Astle & Duggleby, 2024, p. 677)
A
chain
(Astle & Duggleby, 2024, p. 677)
13
Q
The development of an infection occurs in a cycle that depends on the presence of all the following elements:
- An ___ ___ (pathogen)
- A ___ (source for pathogen growth)
- A portal of exit from the ___
- A mode of ___
- A portal of entry to a ___
- A susceptible ___
(Astle & Duggleby, 2024, p. 677)
A
infectious agent
reservoir
reservoir
transmission
host
host
(Astle & Duggleby, 2024, p. 677)
14
Q
Chain of Infection
(Astle & Duggleby, 2024, p. 677)
A
(Astle & Duggleby, 2024, p. 677)
15
Q
As stated earlier, microorganisms include ___, ___, ___ and ___.
(Astle & Duggleby, 2024, p. 677)
A
bacteria
viruses
fungi
protozoa
(Astle & Duggleby, 2024, p. 677)
16
Q
Microorganisms on the skin are called ___ or ___ flora.
(Astle & Duggleby, 2024, p. 677)
A
resident
transient
(Astle & Duggleby, 2024, p. 677)
17
Q
___ microorganisms are considered permanent ___ of the skin, where they survive and multiply without causing harm.
They are not easily removed by handwashing with plain soaps unless considerable friction is used.
(Astle & Duggleby, 2024, p. 677)
A
Resident
residents
(Astle & Duggleby, 2024, p. 677)
18
Q
___ microorganisms in deep skin layers are usually killed only by performing hand hygiene with products containing antimicrobial ingredients.
(Astle & Duggleby, 2024, p. 677)
A
Resident
19
Q
Staphylococcus aureus is a ___ microorganism of the skin.
(Astle & Duggleby, 2024, p. 677)
A
resident
(Astle & Duggleby, 2024, p. 677)
20
Q
___ microorganisms attach to the skin when a person has contact with another person or object.
For example, when a person touches a bedpan or a contaminated dressing, ___ bacteria adhere to their skin.
The organisms attach loosely to the skin in dirt and grease and under fingernails.
These organisms may be readily transmitted unless removed by proper handwashing or hand hygiene.
(Hillier, 2020 as cited in Astle & Duggleby, 2024, p. 677)
A
Transient
transient
(Hillier, 2020 as cited in Astle & Duggleby, 2024, p. 677)
21
Q
Escherichia coli (E. coli) is found in the bowel and is an example of ___ bacteria of the skin.
(Astle & Duggleby, 2024, p. 677)
A
transient
(Astle & Duggleby, 2024, p. 677)
22
Q
The potential for microorganisms to cause disease depends on the following factors:
- A sufficient number of ___
- ___, or the ability to produce disease
- The ability to enter and survive in the ___
- The ___ of the ___
(Astle & Duggleby, 2024, p. 677)
A
organisms
Virulence
host
susceptibility, host
(Astle & Duggleby, 2024, p. 677)
23
Q
A ___ is a place where a pathogen can survive but may or may not multiply.
For example, hepatitis A virus survives in shellfish but does not multiply; Pseudomonas organisms can survive and multiply in nebulizer reservoirs used in the care of patients with respiratory conditions.
(Astle & Duggleby, 2024, p. 677)
A
reservoir
(Astle & Duggleby, 2024, p. 677)
24
Q
The most common ___ is the human body.
A variety of microorganisms live on the skin and within body cavities, fluids, and discharges.
(Astle & Duggleby, 2024, p. 677)
A
reservoir
(Astle & Duggleby, 2024, p. 677)
25
When a pathogen is present on or in the body but does not cause harm, the pathogen is ___ the site.
## Footnote
(Astle & Duggleby, 2024, p. 677)
colonizing
## Footnote
(Astle & Duggleby, 2024, p. 677)
26
___ are animals or persons who show no symptoms of illness but who have pathogens on or in their bodies that can be transferred to others.
For example, a person can be a ___ of hepatitis B virus without having any signs or symptoms of infection.
## Footnote
(Astle & Duggleby, 2024, p. 677)
Carriers
carrier
## Footnote
(Astle & Duggleby, 2024, p. 677)
27
Animals, food, water, insects, and even inanimate objects can also be ___ for infectious organisms.
For example, the bacterium Legionella pneumophila, which causes Legionnaires’ disease, lives in contaminated water and water systems.
## Footnote
(Astle & Duggleby, 2024, p. 677)
reservoirs
## Footnote
(Astle & Duggleby, 2024, p. 677)
28
To thrive, pathogens require a reservoir that provides ___, ___ (or no ___, depending on the pathogen), ___, an appropriate ___ and ___, and minimal ___.
## Footnote
(Astle & Duggleby, 2024, p. 677)
food
oxygen x 2
water
temperature
pH
light
## Footnote
(Astle & Duggleby, 2024, p. 677)
29
EDIT - make into matching game & fix placement
## Footnote
(Astle & Duggleby, 2024, pp. 677, 678)
## Footnote
(Astle & Duggleby, 2024, pp. 677, 678)
30
Microorganisms require nourishment.
Some, such as Clostridium perfringens, the microbe that causes gas gangrene, thrive on organic matter.
Others, such as Escherichia coli, consume undigested ___ in the bowel.
Carbon dioxide and inorganic materials such as soil provide nourishment for other organisms.
## Footnote
(Astle & Duggleby, 2024, p. 678)
food
## Footnote
(Astle & Duggleby, 2024, p. 678)
31
___ bacteria require oxygen to survive and to multiply sufficiently to cause disease.
## Footnote
(Astle & Duggleby, 2024, p. 678)
Aerobic
## Footnote
(Astle & Duggleby, 2024, p. 678)
32
___ organisms cause more infections than do ___organisms (i.e., organisms that can survive only in the absence of oxygen).
## Footnote
(Astle & Duggleby, 2024, p. 678)
Aerobic
anaerobic
## Footnote
(Astle & Duggleby, 2024, p. 678)
33
Examples of ___ organisms are Staphylococcus aureus and strains of Streptococcus organisms.
## Footnote
(Astle & Duggleby, 2024, p. 678)
aerobic
## Footnote
(Astle & Duggleby, 2024, p. 678)
34
The gastrointestinal tract is colonized by large numbers of ___ bacteria that can cause infections if the bowel is damaged.
## Footnote
(Astle & Duggleby, 2024, p. 678)
anaerobic
## Footnote
(Astle & Duggleby, 2024, p. 678)
35
Infections deep within the pleural cavity, in a joint, or in a deep sinus tract are typically caused by ___.
## Footnote
(Astle & Duggleby, 2024, p. 678)
anaerobes
## Footnote
(Astle & Duggleby, 2024, p. 678)
36
Bacteria that cause tetanus, gas gangrene, and botulism are ___.
## Footnote
(Astle & Duggleby, 2024, p. 678)
anaerobes
## Footnote
(Astle & Duggleby, 2024, p. 678)
37
Most organisms require water or moisture for survival.
For example, microorganisms thrive in the moist drainage from a surgical wound.
However, some bacteria assume a form called a ___.
___ remain viable even when deprived of water and are resistant to drying.
## Footnote
(Astle & Duggleby, 2024, p. 678)
spore
Spores
## Footnote
(Astle & Duggleby, 2024, p. 678)
38
___-forming bacteria, such as those that cause anthrax, botulism, and tetanus, can live without water.
## Footnote
(Astle & Duggleby, 2024, p. 678)
Spore
## Footnote
(Astle & Duggleby, 2024, p. 678)
39
Microorganisms can live only in certain ___ ranges.
## Footnote
(Astle & Duggleby, 2024, p. 678)
temperature
## Footnote
(Astle & Duggleby, 2024, p. 678)
40
The ideal temperature for most pathogens in humans is ___°C to ___°C; however, some can survive temperature extremes that would be fatal to humans.
## Footnote
(Taylor, 2018 as cited in Astle & Duggleby, 2024, p. 678)
35
37
## Footnote
(Taylor, 2018 as cited in Astle & Duggleby, 2024, p. 678)
41
(Cold/hot) temperatures tend to prevent the growth and reproduction of bacteria.
## Footnote
(Astle & Duggleby, 2024, p. 678)
Cold
## Footnote
(Astle & Duggleby, 2024, p. 678)
42
The ___ of an environment determines the viability of microorganisms.
## Footnote
(Astle & Duggleby, 2024, p. 678)
acidity
## Footnote
(Astle & Duggleby, 2024, p. 678)
43
Most microorganisms prefer an environment within a pH range of ___ to ___.
## Footnote
(Astle & Duggleby, 2024, p. 678)
5
8
## Footnote
(Astle & Duggleby, 2024, p. 678)
44
Bacteria, in particular, thrive in urine with an ___ pH.
## Footnote
(Astle & Duggleby, 2024, p. 678)
alkaline
## Footnote
(Astle & Duggleby, 2024, p. 678)
45
Most organisms cannot survive the ___ environment of the stomach.
## Footnote
(Astle & Duggleby, 2024, p. 678)
acidic
## Footnote
(Astle & Duggleby, 2024, p. 678)
46
___-reducing medications (e.g., antacids and histamine 2 blockers) can cause an overgrowth of gastrointestinal organisms, which can contribute to development of nosocomial pneumonia.
## Footnote
(Taylor, 2018 as cited in Astle & Duggleby, 2024, p. 678)
Acid
## Footnote
(Taylor, 2018 as cited in Astle & Duggleby, 2024, p. 678)
47
Microorganisms thrive in ___ environments, such as those under dressings and within body cavities.
## Footnote
(Astle & Duggleby, 2024, p. 678)
dark
## Footnote
(Astle & Duggleby, 2024, p. 678)
48
___ light may be effective in killing certain forms of bacteria (e.g., Mycobacterium tuberculosis).
## Footnote
(Astle & Duggleby, 2024, p. 678)
Ultraviolet
## Footnote
(Astle & Duggleby, 2024, p. 678)
49
After microorganisms find a site in which to grow and multiply, they must find a portal of exit if they are to enter another ___ and cause disease.
## Footnote
(Astle & Duggleby, 2024, p. 678)
host
## Footnote
(Astle & Duggleby, 2024, p. 678)
50
A ___ of ___ is the path by which the pathogen leaves the reservoir.
## Footnote
(AusMed, 2020 as cited in Astle & Duggleby, 2024, p. 678)
**portal** of **exit**
## Footnote
(AusMed, 2020 as cited in Astle & Duggleby, 2024, p. 678)
51
Exits in the human body include body openings (___, ___, ___, ___, and ___l openings; and ___ openings such as those resulting from ostomies), breaks in the skin (a scrape, cut, or other wound), and breaks in the ___ ___ (the skin in the mouth, eyes, nose, vagina, and rectum).
## Footnote
(Astle & Duggleby, 2024, p. 678)
mouth
nose
rectal
vaginal
urethral
artificial
mucous membranes
## Footnote
(Astle & Duggleby, 2024, p. 678)
52
___ are carried through portals of exit by blood, body fluids, excretions, and secretions (e.g., urine, stool, vomitus, saliva, mucus, pus, vaginal discharge, semen, wound drainage, bile, and sputum).
For example, ___ that infect the respiratory tract, such as M. tuberculosis, can be released from the body through the mouth and nose when an infected person sneezes, coughs, talks, or even breathes.
## Footnote
(Astle & Duggleby, 2024, p. 678)
Pathogens
pathogens
## Footnote
(Astle & Duggleby, 2024, p. 678)
53
In patients with artificial airways such as tracheostomy or endotracheal tubes, organisms easily ___ the respiratory tract through these devices.
Similarly, when a patient has a urinary tract infection, microorganisms ___ during urination or through urinary diversions such as ileal conduits, urostomies, and suprapubic drains.
## Footnote
(Astle & Duggleby, 2024, p. 678)
exit
exit
## Footnote
(Astle & Duggleby, 2024, p. 678)
54
Microorganisms can be transmitted from the ___ to the ___ in many ways.
## Footnote
(Astle & Duggleby, 2024, p. 679)
reservoir
host
## Footnote
(Astle & Duggleby, 2024, p. 679)
55
Certain infectious diseases tend to be transmitted more commonly by specific modes.
However, a microorganism may be transmitted by more than one mode.
For example, human chicken pox virus may be spread by the ___ route or through ___ contact.
## Footnote
(Astle & Duggleby, 2024, p. 679)
airborne
direct
## Footnote
(Astle & Duggleby, 2024, p. 679)
56
___ contact is a major mode of transmission in health care facilities.
The health care worker’s hands can easily pick up microbes from one person, place, or thing and then transmit them to other people, places, or things.
However, almost any object within the environment (e.g., a stethoscope or thermometer) can be a mode of ___ transmission of pathogens.
## Footnote
(Astle & Duggleby, 2024, p. 679)
Indirect
indirect
## Footnote
(Astle & Duggleby, 2024, p. 679)
57
Some organisms, such as Clostridioides difficile , which can produce ___, can live in hospital environments for months.
C. difficile can be spread by ___ or ___ contact.
## Footnote
(Astle & Duggleby, 2024, p. 679)
spores
direct, indirect
## Footnote
(Astle & Duggleby, 2024, p. 679)
58
All health care workers providing direct care (e.g., nurses and licensed practical nurses, physiotherapists, and physicians) or performing diagnostic and support services (e.g., laboratory technicians, respiratory therapists, and dietary workers) must follow practices to minimize the spread of infection.
Each group follows procedures for handling equipment and supplies used by a patient.
For example, respiratory therapists perform ___ ___ before working with each patient and dispose of contaminated therapy equipment in a prescribed manner.
## Footnote
(Astle & Duggleby, 2024, p. 679)
hand hygiene
## Footnote
(Astle & Duggleby, 2024, p. 679)
59
Certain medical devices and diagnostic procedures provide avenues for the spread of pathogens.
___ procedures such as cystoscopy (the use of an endoscope to visualize the bladder) facilitate the diagnosis of health problems but also increase the risk of infection transmission.
## Footnote
(Astle & Duggleby, 2024, p. 679)
Invasive
## Footnote
(Astle & Duggleby, 2024, p. 679)
60
Because so many factors can promote the spread of infection to a patient, all health care workers must be conscientious about using infection-control practices, such as performing proper ___ and ensuring that equipment has been adequately ___, ___, or ___.
## Footnote
(Astle & Duggleby, 2024, p. 679)
hand hygiene
cleaned
disinfected
sterilized
## Footnote
(Astle & Duggleby, 2024, p. 679)
61
EDIT - make into matching game & fix placement
## Footnote
(Astle & Duggleby, 2024, p. 680)
## Footnote
(Astle & Duggleby, 2024, p. 680)
62
Organisms can ___ the body through the same routes they use to ___ (i.e., body openings and breaks in the skin or mucous membranes).
For example, organisms ___ the body when a needle pierces the skin.
As long as the device is in place, more organisms are able to enter the body.
## Footnote
(Astle & Duggleby, 2024, p. 680)
enter, exit
enter
## Footnote
(Astle & Duggleby, 2024, p. 680)
63
In patients with a urinary catheter, any obstruction to the flow of urine allows organisms to travel up the urethra.
Factors that reduce the body’s ___ enhance the chances of pathogens entering the body.
## Footnote
(Astle & Duggleby, 2024, p. 680)
defences
## Footnote
(Astle & Duggleby, 2024, p. 680)
64
Whether a person acquires an infection is related to their ___ to an infectious agent—___ depends on the individual’s degree of resistance to a pathogen.
## Footnote
(Astle & Duggleby, 2024, p. 680)
susceptibility x 2
## Footnote
(Astle & Duggleby, 2024, p. 680)
65
Although everyone is constantly in contact with large numbers of microorganisms, an infection does not develop until an individual becomes ___ to the strength and numbers of microorganisms capable of producing infection.
## Footnote
(Astle & Duggleby, 2024, p. 680)
susceptible
## Footnote
(Astle & Duggleby, 2024, p. 680)
66
The more ___ an organism is, the greater the likelihood that a person will be susceptible to it.
## Footnote
(Astle & Duggleby, 2024, p. 680)
virulent
## Footnote
(Astle & Duggleby, 2024, p. 680)
67
Organisms with ___ to antibiotics are becoming more common in acute care settings—this is believed to be associated with the frequent and sometimes inappropriate use of antibiotics.
## Footnote
(Astle & Duggleby, 2024, p. 680)
resistance
## Footnote
(Astle & Duggleby, 2024, p. 680)
68
A person’s ___ to an infectious agent may be enhanced by receiving an appropriate vaccine or actually contracting the disease.
## Footnote
(Astle & Duggleby, 2024, p. 680)
resistance
## Footnote
(Astle & Duggleby, 2024, p. 680)
69
By understanding the ___ of infection, nurses can intervene to prevent infections from developing.
If a patient is at risk for acquiring an infection, the nurse should observe for signs and symptoms of infection and take appropriate actions to prevent its spread.
## Footnote
(Astle & Duggleby, 2024, p. 680)
chain
## Footnote
(Astle & Duggleby, 2024, p. 680)
70
___ follow a progressive course.
## Footnote
(Astle & Duggleby, 2024, p. 680)
Infections
## Footnote
(Astle & Duggleby, 2024, p. 680)
71
The severity of a patient’s illness depends on the extent of the infection, the ability of the microorganism to cause disease (___ of the microorganisms), and the ___ of the host (patient).
## Footnote
(Astle & Duggleby, 2024, p. 680)
pathogenicity
susceptibility
## Footnote
(Astle & Duggleby, 2024, p. 680)
72
If infection is ___, or restricted to a limited area (e.g., a wound infection), proper care controls the spread and minimizes the illness.
The patient may experience ___ symptoms such as pain and tenderness at the wound site.
## Footnote
(Astle & Duggleby, 2024, p. 680)
localized
localized
## Footnote
(Astle & Duggleby, 2024, p. 680)
73
An infection that affects the entire body instead of just a single organ or part is ___ and can be fatal.
## Footnote
(Astle & Duggleby, 2024, p. 680)
systemic
## Footnote
(Astle & Duggleby, 2024, p. 680)
74
The ___ of an infection influences the level of nursing care provided. Nurses are responsible for properly administering antibiotics and monitoring the response to medication therapy.
___ therapy includes providing adequate nutrition and rest to bolster the patient’s defences against the infectious process.
The complexity of care depends on body systems affected by the infection.
## Footnote
(Astle & Duggleby, 2024, p. 680)
course
Supportive
## Footnote
(Astle & Duggleby, 2024, p. 680)
75
Regardless of whether an infection is localized or systemic, nurses play a critical role in minimizing its ___.
For example, an organism causing a simple wound infection can ___ to involve an intravenous needle–insertion site if the nurse uses an improper technique when changing a dressing at this site.
Nurses who have breaks in their own skin can also acquire infections from patients if their techniques for controlling infection ___ are inadequate
## Footnote
(Astle & Duggleby, 2024, p. 680)
spread
spread
transmission
## Footnote
(Astle & Duggleby, 2024, p. 680)
76
## Footnote
(Astle & Duggleby, 2024, p. 680)
## Footnote
(Astle & Duggleby, 2024, p. 680)
77
___ body flora that live inside and outside the body protect a person from several pathogens.
## Footnote
(Astle & Duggleby, 2024, p. 680)
Normal
## Footnote
(Astle & Duggleby, 2024, p. 680)
78
Each organ system has ___ ___ that fight infectious microorganisms.
## Footnote
(Astle & Duggleby, 2024, p. 680)
defence mechanisms
## Footnote
(Astle & Duggleby, 2024, p. 680)
79
The ___ response is a protective reaction that neutralizes pathogens and repairs body cells.
## Footnote
(Astle & Duggleby, 2024, p. 680)
immune
## Footnote
(Astle & Duggleby, 2024, p. 680)
80
The immune system is composed of cells and molecules that help the body resist disease; certain responses of the immune system are ___ and protect against microorganisms regardless of prior exposure (e.g., normal flora, body system defences, and inflammation), whereas others are ___ defences against particular pathogens.
## Footnote
(Astle & Duggleby, 2024, p. 680)
nonspecific
specific
## Footnote
(Astle & Duggleby, 2024, p. 680)
81
If any of the body’s ___ fail, an infection can quickly progress to a serious health problem.
## Footnote
(Astle & Duggleby, 2024, p. 680)
defences
## Footnote
(Astle & Duggleby, 2024, p. 680)
82
EDIT - make into matching game & fix placement
## Footnote
(Astle & Duggleby, 2024, p. 680)
## Footnote
(Astle & Duggleby, 2024, p. 680)
83
The body normally contains microorganisms that reside on the surface and in deep layers of skin, in the saliva and oral mucosa, and in the gastrointestinal and genitourinary tracts.
A person normally excretes trillions of microbes daily through the intestines.
The skin also has a large population of ___ flora—these normal flora do not typically cause disease when residing in their usual area of the body but, instead, participate in maintaining health.
## Footnote
(Astle & Duggleby, 2024, p. 680)
resident
## Footnote
(Astle & Duggleby, 2024, p. 680)
84
___ flora of the large intestine exist in great numbers without causing injury.
## Footnote
(Astle & Duggleby, 2024, p. 680)
Normal
## Footnote
(Astle & Duggleby, 2024, p. 680)
85
___ flora may assist in fighting infection and inflammation and maintaining homeostasis.
Gut microorganisms change dietary fibre into fatty acids, which are reabsorbed by the large bowel and synthesize vitamins B and K, bile acids, and sterols; this synthesis has a benefit to both the host and the flora.
Bile has antibacterial properties as well as fatty acids that stabilize the ___ flora populations and prevent invasion of pathogens.
## Footnote
(Howerton et al., 2018 as cited in Astle & Duggleby, 2024, p. 680)
Normal
normal
## Footnote
(Howerton et al., 2018 as cited in Astle & Duggleby, 2024, p. 680)
86
When the ___ flora are disrupted, disease-causing organisms can proliferate.
## Footnote
(Astle & Duggleby, 2024, p. 680)
normal
## Footnote
(Astle & Duggleby, 2024, p. 680)
87
The skin’s ___ flora exert a protective action by inhibiting the multiplication of organisms landing on the skin.
The mouth and pharynx are also protected by flora that impair the growth of invading microbes.
## Footnote
(Astle & Duggleby, 2024, p. 680)
normal
## Footnote
(Astle & Duggleby, 2024, p. 680)
88
The mass of ___ flora maintains a sensitive balance with other microorganisms to prevent infection.
Any factor that disrupts this balance places a person at increased risk for acquiring an infectious disease.
For example, according to studies, when a patient acquires microorganisms within the hospital, the person’s ___ flora change, which may lead to an infection.
## Footnote
(Prinzi, 2020 as cited in Astle & Duggleby, 2024, p. 680)
normal
resident
## Footnote
(Prinzi, 2020 as cited in Astle & Duggleby, 2024, p. 680)
89
In addition, the use of ___-___ antibiotics for the treatment of infection can lead to a ___, which develops when ___-___ antibiotics eliminate a wide range of microorganisms, not just those causing infection.
Normal bacterial flora are eliminated, reducing the body’s defences and thus allowing disease-producing microorganisms to multiply. An example is Clostridioides difficile (C. diff).
## Footnote
(Lishman et al., 2018 as cited in Astle & Duggleby, 2024, p. 680)
**broad**-**spectrum**
superinfection
**broad**-**spectrum**
## Footnote
(Lishman et al., 2018 as cited in Astle & Duggleby, 2024, p. 680)
90
A number of the body’s organ systems have unique ___ against infection.
The skin, respiratory tract, and gastrointestinal tract are easily accessible to microorganisms: pathogenic organisms easily adhere to the skin’s surface, are inhaled into the lungs, or are ingested with food.
## Footnote
(Astle & Duggleby, 2024, p. 681)
defences
## Footnote
(Astle & Duggleby, 2024, p. 681)
91
Each organ system has defence mechanisms physiologically suited to its structure and function.
For example, the lungs cannot completely control the entrance of microorganisms; however, the airways are lined with hair-like projections (___) that rhythmically beat to move a blanket of mucus and adherent or trapped organisms up to the pharynx to be removed.
Conditions that impair an organ’s specialized defences increase the person’s ___ to infection.
## Footnote
(Astle & Duggleby, 2024, p. 681)
cilia
susceptibility
## Footnote
(Astle & Duggleby, 2024, p. 681)
92
___ is the body’s cellular response to injury or infection.
## Footnote
(Astle & Duggleby, 2024, p. 681)
Inflammation
## Footnote
(Astle & Duggleby, 2024, p. 681)
93
___ is a protective vascular reaction that delivers fluid, blood products, and nutrients to interstitial tissues in an area of injury.
The process neutralizes and eliminates pathogens or necrotic (dead) tissues and establishes a means of repairing body cells and tissues.
## Footnote
(Astle & Duggleby, 2024, p. 681)
Inflammation
## Footnote
(Astle & Duggleby, 2024, p. 681)
94
Signs of ___ ___ are swelling, redness, heat, pain or tenderness, and loss of function in the affected body part.
When infection becomes ___, other signs and symptoms develop, including fever, leukocytosis, malaise, anorexia, nausea, vomiting, and lymph node enlargement.
## Footnote
(Astle & Duggleby, 2024, p. 681)
localized inflammation
systemic
## Footnote
(Astle & Duggleby, 2024, p. 681)
95
The ___ ___ may be triggered by physical agents, chemical agents, or microorganisms.
Mechanical trauma, temperature extremes, and radiation are examples of ___ agents.
___ agents include external and internal irritants, such as harsh poisons and gastric acid.
## Footnote
(Astle & Duggleby, 2024, p. 681)
inflammatory response
physical
Chemical
## Footnote
(Astle & Duggleby, 2024, p. 681)
96
After tissues are injured, the inflammatory response, a series of well-coordinated events, occurs:
* ___ and ___ responses
* The formation of inflammatory ___ (fluid and cells that are discharged from cells or blood vessels, e.g., pus or serum)
* Tissue ___
## Footnote
(Astle & Duggleby, 2024, p. 681)
Vascular, cellular
exudates
repair
## Footnote
(Astle & Duggleby, 2024, p. 681)
97
___ inflammation is an immediate response to cellular injury.
Arterioles supplying the infected or injured area dilate, allowing more blood into the local circulation.
The increase in local blood flow causes the characteristic redness of inflammation.
The symptom of localized warmth results from a greater volume of blood at the inflammatory site.
Local ___ enables blood and white blood cells (WBCs) to travel to the injured tissues.
## Footnote
(Astle & Duggleby, 2024, p. 681)
Acute
vasodilation
## Footnote
(Astle & Duggleby, 2024, p. 681)
98
EDIT - make into matching game & fix placement
## Footnote
(Astle & Duggleby, 2024, p. 682)
## Footnote
(Astle & Duggleby, 2024, p. 682)
99
Injury causes tissue necrosis, and, as a result, the body releases ___, ___, ___, and ___.
These chemical mediators increase the permeability of small blood vessels, allowing fluid, protein, and cells to enter interstitial spaces.
Accumulated fluid appears as localized swelling (___).
## Footnote
(Astle & Duggleby, 2024, p. 682)
histamine, bradykinin, prostaglandin, serotonin
edema
## Footnote
(Astle & Duggleby, 2024, p. 682)
100
Another symptom of inflammation is ___—the swelling of inflamed tissues increases the pressure on nerve endings, causing ___.
## Footnote
(Astle & Duggleby, 2024, p. 682)
pain x 2
## Footnote
(Astle & Duggleby, 2024, p. 682)
101
Chemical substances such as ___ stimulate nerve endings.
As a result of physiological changes occurring with inflammation, the involved body part usually undergoes a temporary loss of function.
For example, a localized infection of the hand causes the fingers to become swollen, painful, and discoloured.
Joints may become stiff as a result of the swelling, but the function of the fingers returns when inflammation subsides.
## Footnote
(Astle & Duggleby, 2024, p. 682)
histamine
## Footnote
(Astle & Duggleby, 2024, p. 682)
102
The cellular response of inflammation involves ___ ___ ___ (___) arriving at the site.
These cells pass through the blood vessels and into the tissues.
## Footnote
(Astle & Duggleby, 2024, p. 682)
white blood cells (WBC)
## Footnote
(Astle & Duggleby, 2024, p. 682)
103
Through the process of ___, specialized white blood cells (WBC), called neutrophils and monocytes, ingest and destroy microorganisms and other small particles.
## Footnote
(Astle & Duggleby, 2024, p. 682)
phagocytosis
## Footnote
(Astle & Duggleby, 2024, p. 682)
104
As inflammation becomes systemic, other signs and symptoms develop.
___, or an increase in the number of circulating white blood cells (WBC), is the body’s response to white blood cells (WBC) leaving blood vessels.
## Footnote
(Astle & Duggleby, 2024, p. 682)
Leukocytosis
## Footnote
(Astle & Duggleby, 2024, p. 682)
105
A serum white blood cell (WBC) count is normally ___/mm3 to ___/mm3 but may rise to _--/mm3 or even higher during inflammation.
## Footnote
(Astle & Duggleby, 2024, p. 682)
5000
10000
15000
## Footnote
(Astle & Duggleby, 2024, p. 682)
106
___ is caused by the phagocytic release of pyrogens from bacterial cells that cause a rise in the hypothalamic set point.
## Footnote
(Astle & Duggleby, 2024, p. 682)
Fever
## Footnote
(Astle & Duggleby, 2024, p. 682)
107
The accumulation of fluid, dead tissue cells, and white blood cells (WBC) forms an exudate at the site of inflammation.
The ___ may be ___ (clear, watery plasma), ___ (bloody drainage), ___ (thin, watery drainage that is blood tinged), or ___ (thick drainage that contains pus).
Eventually, the exudate is cleared away through lymphatic drainage.
## Footnote
(Astle & Duggleby, 2024, p. 682)
serous, sanguineous, serosanguineous, purulent
## Footnote
(Astle & Duggleby, 2024, p. 682)
108
___ and ___ ___ such as fibrinogen form a meshlike matrix at the site of inflammation to prevent the spread of infection.
## Footnote
(Astle & Duggleby, 2024, p. 682)
Platelets
plasma proteins
## Footnote
(Astle & Duggleby, 2024, p. 682)
109
When tissues are injured, healing involves the ___, ___, and ___ stages.
Damaged cells are eventually replaced with healthy new ones, which undergo a gradual maturation until they take on the same structural characteristics and appearance as the previous cells.
However, unless a wound is minor, the healed wound does not usually have the tensile strength of the tissue it replaces, and scarring may occur.
## Footnote
(Astle & Duggleby, 2024, p. 682)
inflammation
proliferation
remodelling
## Footnote
(Astle & Duggleby, 2024, p. 682)
110
Patients in health care settings have an increased risk of acquiring infections.
A health care–associated infection (HAI), also known as ___infection or ___ infection, is an infection acquired after admission to a health care facility that was not present or incubating at the time of admission.
Patients in hospitals are at risk for infections because they may have a high acuity of illness and frequently undergo aggressive treatments, many of which compromise ___.
Transmission of antibiotic-___ organisms also can occur in health care facilities because a large population of susceptible people who frequently receive antibiotics are in close proximity to each other.
## Footnote
(Public Health Agency of Canada [PHAC], 2020a as cited in Astle & Duggleby, 2024, p. 682)
nosocomial, iatrogenic
immunity
resistant
## Footnote
(Public Health Agency of Canada [PHAC], 2020a as cited in Astle & Duggleby, 2024, p. 682)
111
___ ___ ___ (___) is one of the most common and costly health care–associated infections (HAI).
___ ___ (___. ___) is a Gram-positive, spore-forming, anaerobic bacillus that produces two toxins, A and B, which cause diarrhea and colitis in patients whose bacterial flora have been disrupted by prior antibiotic use.
## Footnote
(Astle & Duggleby, 2024, p. 682)
Clostridioides difficile infection (CDI)
Clostridioides difficile (**C**. **difficile**)
## Footnote
(Astle & Duggleby, 2024, p. 682)
112
___ ___ (___) is a more severe form of clostridioides difficile infection (CDI), in which patients have a colitis characterized by the presence of pseudomembranes on the colon surface seen during endoscopy.
## Footnote
(Astle & Duggleby, 2024, p. 682)
Pseudomembranous colitis (**PMC**)
## Footnote
(Astle & Duggleby, 2024, p. 682)
113
Infection-control measures to prevent transmission of ___ ___ (___. ___) to patients include placing the patient on contact isolation, good hand hygiene (preferably with soap and water for patients who have diarrhea), gloves and gowns, as well as thorough environmental cleaning.
Another important preventative measure is good antibiotic stewardship.
## Footnote
(Centers for Disease Control and Prevention [CDC], 2019a as cited in Astle & Duggleby, 2024, p. 682)
clostridioides difficile (**C**. **difficile**)
## Footnote
(Centers for Disease Control and Prevention [CDC], 2019a as cited in Astle & Duggleby, 2024, p. 682)
114
___ ___-___ ___ (___) can result from a diagnostic or therapeutic procedure, such as a urinary tract infection that develops after catheter insertion.
## Footnote
(Astle & Duggleby, 2024, p. 682)
**Health** **care**–**associated** **infection** (**HAI**)
## Footnote
(Astle & Duggleby, 2024, p. 682)
115
The incidence of ___ infections can be reduced if nurses use critical thinking when practising aseptic techniques.
Nurses should always consider the patient’s risks for infection and anticipate how the approach to care may increase or decrease the chances of infection transmission.
## Footnote
(Astle & Duggleby, 2024, p. 682)
nosocomial
## Footnote
(Astle & Duggleby, 2024, p. 682)
116
Health care–associated infections (HAI) may be ___ or ___.
## Footnote
(Astle & Duggleby, 2024, p. 682)
exogenous, endogenous
## Footnote
(Astle & Duggleby, 2024, p. 682)
117
An ___ infection arises from microorganisms external to the individual that do not exist as normal flora; examples are Salmonella organisms and Clostridium tetani.
## Footnote
(Astle & Duggleby, 2024, p. 682)
exogenous
## Footnote
(Astle & Duggleby, 2024, p. 682)
118
An ___ infection can occur when some of the patient’s flora become altered and overgrowth results.
Examples are infections caused by enterococci, yeasts, and streptococci.
## Footnote
(Astle & Duggleby, 2024, p. 682)
endogenous
## Footnote
(Astle & Duggleby, 2024, p. 682)
119
When sufficient numbers of microorganisms normally found in one body cavity or lining are transferred to another body site, an ___ infection develops.
For example, the transmission of enterococci, normally found in fecal material, from the hands to the skin is a common cause of wound infections.
## Footnote
(Astle & Duggleby, 2024, p. 682)
endogenous
## Footnote
(Astle & Duggleby, 2024, p. 682)
120
The number of microorganisms needed to cause an infection depends on the ___ of the organism, the host’s ___, and the site affected.
## Footnote
(Astle & Duggleby, 2024, p. 682)
virulence
susceptibility
## Footnote
(Astle & Duggleby, 2024, p. 682)
121
A patient’s risk for infection is influenced by the number of health care workers having ___ contact with the patient, the type and number of ___ procedures the patient has undergone, the therapy received, and the ___ of hospitalization.
## Footnote
(Astle & Duggleby, 2024, p. 682)
direct
invasive
length
## Footnote
(Astle & Duggleby, 2024, p. 682)
122
Major sites for ___ ___-___ ___ (___) are surgical and traumatic wounds, urinary and respiratory tracts, and the bloodstream.
## Footnote
(Astle & Duggleby, 2024, p. 682)
**health** **care**–**associated** **infections** (**HAI**)
## Footnote
(Astle & Duggleby, 2024, p. 682)
123
Older persons have an increased susceptibility to ___ ___-___ ___ (___) because they are more likely to have a chronic disease and because of the effects of the aging process itself.
## Footnote
(Astle & Duggleby, 2024, p. 682)
**health** **care**–**associated** **infections** (**HAI**)
## Footnote
(Astle & Duggleby, 2024, p. 682)
124
Extended stays in health care institutions, increased disability, and prolonged recovery times are all potential outcomes of ___ ___-___ ___ (___).
## Footnote
(Astle & Duggleby, 2024, p. 682)
**health** **care**–**associated** **infections** (**HAI**)
## Footnote
(Astle & Duggleby, 2024, p. 682)
125
___ ___-___ ___ (___) decrease the patient’s quality of life and increase costs to the health care system.
Therefore, their ___ is an important part of managed care.
## Footnote
(Astle & Duggleby, 2024, p. 682)
**Health** **care**–**associated** **infections** (**HAI**)
prevention
## Footnote
(Astle & Duggleby, 2024, p. 682)
126
When considering infection prevention, the nurse must assess a patient’s ___ ___, ___, and knowledge of infections.
## Footnote
(Astle & Duggleby, 2024, p. 682)
defence mechanisms
susceptibility
## Footnote
(Astle & Duggleby, 2024, p. 682)
127
A review of disease ___ with the patient and family may reveal an exposure to a communicable disease.
## Footnote
(Astle & Duggleby, 2024, p. 682)
history
## Footnote
(Astle & Duggleby, 2024, p. 682)
128
A thorough review of the patient’s clinical condition may allow the nurse to detect signs and symptoms of an infection or a ___ for infection.
## Footnote
(Astle & Duggleby, 2024, p. 682)
risk
## Footnote
(Astle & Duggleby, 2024, p. 682)
129
Information about the patient’s ___ against infection can be determined by an analysis of laboratory findings.
## Footnote
(Astle & Duggleby, 2024, p. 682)
defences
## Footnote
(Astle & Duggleby, 2024, p. 682)
130
By knowing the factors that increase ___ or risk for infection, nurses are better able to plan preventive therapy that includes aseptic techniques.
## Footnote
(Astle & Duggleby, 2024, p. 682)
susceptibility
## Footnote
(Astle & Duggleby, 2024, p. 682)
131
With recognition of early ___ and ___ of infection, nurses can alert others on the health care team to the potential need for therapy and to initiate supportive nursing measures.
## Footnote
(Astle & Duggleby, 2024, p. 682)
signs
symptoms
## Footnote
(Astle & Duggleby, 2024, p. 682)
132
Nurses can determine the status of a patient’s normal ___ ___ against infection through a review of the physical assessment findings and the patient’s medical condition.
For example, any break in the skin or mucosa is a potential site for infection.
Similarly, a chronic smoker is at greater risk for acquiring a respiratory tract infection after general surgery because the cilia of the lung are less likely to propel retained mucus from the lung’s airways.
## Footnote
(Astle & Duggleby, 2024, p. 682)
defence mechanisms
## Footnote
(Astle & Duggleby, 2024, p. 682)
133
Any reduction in the body’s primary or secondary defences against infection places a patient at ___.
## Footnote
(Astle & Duggleby, 2024, p. 682)
risk
## Footnote
(Astle & Duggleby, 2024, p. 682)
134
EDIT - make into matching game & fix placement
## Footnote
(Astle & Duggleby, 2024, pp. 683, 684)
## Footnote
(Astle & Duggleby, 2024, pp. 683, 684)
135
EDIT - make into matching game
## Footnote
(Astle & Duggleby, 2024, p. 684)
## Footnote
(Astle & Duggleby, 2024, p. 683)
136
EDIT - make into matching game & fix placement
## Footnote
(Astle & Duggleby, 2024, p. 684)
## Footnote
(Astle & Duggleby, 2024, p. 684)
137
EDIT - make into matching game & fix placement
## Footnote
(Astle & Duggleby, 2024, p. 684)
138
By recognizing and assessing a patient’s ___ factors and implementing appropriate measures, nurses can reduce the risk of infection.
## Footnote
(Astle & Duggleby, 2024, p. 690)
risk
## Footnote
(Astle & Duggleby, 2024, p. 690)
139
Nurses may ___ an infection from developing or spreading by minimizing the numbers and kinds of organisms transmitted to potential infection sites.
## Footnote
(Astle & Duggleby, 2024, p. 690)
prevent
## Footnote
(Astle & Duggleby, 2024, p. 690)
140
Eliminating ___ of infection, controlling portals of ___ and ___, and avoiding actions that transmit microorganisms prevent pathogens from finding a new site in which to grow.
## Footnote
(Astle & Duggleby, 2024, p. 690)
reservoirs
exit
entry
## Footnote
(Astle & Duggleby, 2024, p. 690)
141
The proper use of ___ supplies, ___ protection, and proper ___ ___ are examples of methods that nurses use to control the spread of microorganisms.
## Footnote
(Astle & Duggleby, 2024, p. 690)
sterile
barrier
hand hygiene
## Footnote
(Astle & Duggleby, 2024, p. 690)
142
A further preventive measure is to strengthen a potential host’s defences against infection.
___ support, ___, maintenance of physiological protective mechanisms, and receipt of recommended ___ protect a patient from invasion by pathogens.
## Footnote
(Astle & Duggleby, 2024, p. 690)
Nutritional
rest
immunizations
## Footnote
(Astle & Duggleby, 2024, p. 690)
143
EDIT - placement is fine
## Footnote
(Astle & Duggleby, 2024, p. 689)
144
Being vigilant about infection control helps nurses to apply good medical–surgical ___ practices at the right time and in the right clinical situation.
## Footnote
(Astle & Duggleby, 2024, p. 690)
aseptic
## Footnote
(Astle & Duggleby, 2024, p. 690)
145
When a patient develops an infection, the nurse needs to continue ___ care so that health care personnel and other patients are not exposed to the infection.
## Footnote
(Astle & Duggleby, 2024, p. 690)
preventive
## Footnote
(Astle & Duggleby, 2024, p. 690)
146
___ precautions may be necessary for patients with communicable diseases; the environment is controlled by barriers against the transmission of infection.
## Footnote
(Astle & Duggleby, 2024, p. 690)
Isolation
## Footnote
(Astle & Duggleby, 2024, p. 690)
147
___ diseases are infectious diseases that spread disease from one person to another.
They are caused by bacteria, fungi, or viruses.
The transmission may be direct, indirect, droplet, airborne, or vehicle.
Examples include influenza, HIV, salmonella, E. coli, TB, malaria, Coronavirus, Ebola, MRSA, meningitis, cholera, chickenpox, West Nile virus, SARS, avian influenza, and H1N1.
Prevention against the spread of these diseases includes good hand hygiene, surface cleansing, the use of protective equipment, vaccinations, isolation, and education and training of health care staff.
## Footnote
(Astle & Duggleby, 2024, p. 690)
Communicable
## Footnote
(Astle & Duggleby, 2024, p. 690)
148
Many health care centres are already taxed trying to meet the current demand for services, so a ___ limits their ability to handle a large influx of patients.
Communication between centres, the community, and emergency management organizations is of vital importance to deal with an influx of infectious patients.
Resources and guidance for infection control and prevention are found at federal, regional, and local levels.
They assist in the planning and organization of centres to stop the spread of disease, coordinate resources, and manage care.
## Footnote
(Astle & Duggleby, 2024, p. 690)
pandemic
## Footnote
(Astle & Duggleby, 2024, p. 690)
149
When a ___ occurs, there is no time to plan; rather, plans that were previously developed need to be implemented.
## Footnote
(Joint Commission, 2019 as cited in Astle & Duggleby, 2024, p. 690)
pandemic
## Footnote
(Joint Commission, 2019 as cited in Astle & Duggleby, 2024, p. 690)
150
Treatment of an infectious process includes eliminating the infectious organisms and supporting the patient’s defences.
To identify the causative organism, nurses may collect specimens of ___ ___ or ___ from infected body sites for cultures.
## Footnote
(Astle & Duggleby, 2024, p. 690)
body fluids
drainage
## Footnote
(Astle & Duggleby, 2024, p. 690)
151
When the disease process or causative organism has been identified, the prescriber prescribes the treatment that is most effective for the situation.
Nurses properly administer ___ and other treatments, watch for ___ ___, and assess the ___ of the infection.
## Footnote
(Astle & Duggleby, 2024, p. 690)
antibiotics
adverse reactions
progress
## Footnote
(Astle & Duggleby, 2024, p. 690)
152
___ infections necessitate measures to prevent complications of fever.
Maintaining the patient’s intake of fluids prevents dehydration resulting from ___.
Because of the patient’s increased metabolic rate, adequate nutritional intake must be ensured.
Rest preserves energy for the healing process.
## Footnote
(Astle & Duggleby, 2024, p. 690)
Systemic
diaphoresis
## Footnote
(Astle & Duggleby, 2024, p. 690)
153
___ infections often necessitate measures to remove debris to promote healing.
Nurses need to apply the principles of wound care to remove any infected drainage from the wound site and support the integrity of healing wounds.
Special dressings can be applied to facilitate the removal of infectious drainage and promote healing of wound margins.
Drainage ___ may be inserted to remove infected drainage from body cavities.
Nurses must use medical and surgical ___ techniques to manage wounds and ensure correct handling of all drainage or body fluids.
## Footnote
(Astle & Duggleby, 2024, p. 690)
Localized
tubes
aseptic
## Footnote
(Astle & Duggleby, 2024, p. 690)
154
During the course of infection, nurses can support the patient’s body defence mechanisms.
For example, if a patient has infectious diarrhea, the nurse must maintain ___ integrity to prevent breakdown and the entrance of microorganisms.
Other routine hygiene measures such as bathing and oral care protect the ___ and ___ ___ from invasion and overgrowth of microorganisms.
## Footnote
(Astle & Duggleby, 2024, p. 690)
skin
skin, mucous membranes
## Footnote
(Astle & Duggleby, 2024, p. 690)
155
Nurses’ efforts to minimize the onset and spread of infection are based on the principles of ___ technique.
## Footnote
(Astle & Duggleby, 2024, p. 690)
aseptic
## Footnote
(Astle & Duggleby, 2024, p. 690)
156
___ is the process for keeping away disease-producing microorganisms.
## Footnote
(Astle & Duggleby, 2024, p. 690)
Asepsis
## Footnote
(Astle & Duggleby, 2024, p. 690)
157
___ technique refers to practices designed to render an area and objects as free from microorganisms as possible.
## Footnote
(Astle & Duggleby, 2024, p. 690)
Aseptic
## Footnote
(Astle & Duggleby, 2024, p. 690)
158
The two types of aseptic technique are ___ asepsis and ___ asepsis.
## Footnote
(Astle & Duggleby, 2024, p. 690)
medical
surgical
## Footnote
(Astle & Duggleby, 2024, p. 690)
159
___ ___, or clean technique, includes procedures used to reduce and prevent the spread of microorganisms.
## Footnote
(Astle & Duggleby, 2024, p. 690)
Medical asepsis
## Footnote
(Astle & Duggleby, 2024, p. 690)
160
Hand hygiene, using clean gloves (i.e., disposable gloves) to prevent direct contact with blood or body fluids, and cleaning the environment routinely are examples of ___ ___.
## Footnote
(Astle & Duggleby, 2024, p. 690)
medical asepsis
## Footnote
(Astle & Duggleby, 2024, p. 690)
161
The principles of ___ ___ are commonly followed in the home, as in washing hands before preparing food.
## Footnote
(Astle & Duggleby, 2024, p. 690)
medical asepsis
## Footnote
(Astle & Duggleby, 2024, p. 690)
162
After an object becomes unsterile or unclean, it is considered ___.
## Footnote
(Astle & Duggleby, 2024, p. 690)
contaminated
## Footnote
(Astle & Duggleby, 2024, p. 690)
163
In ___ ___, an area or object is considered contaminated if it contains or is suspected of containing microorganisms.
For example, a used bedpan, the floor, and a used dressing are contaminated.
## Footnote
(Astle & Duggleby, 2024, p. 690)
medical asepsis
## Footnote
(Astle & Duggleby, 2024, p. 690)
164
During daily routine care, nurses use basic ___ ___ techniques to break the infection chain.
## Footnote
(Astle & Duggleby, 2024, p. 690)
medical aseptic
## Footnote
(Astle & Duggleby, 2024, p. 690)
165
Because infections are readily transmitted between patients and caregivers, it may become necessary for the nurse to follow ___ precautions as appropriate.
## Footnote
(Astle & Duggleby, 2024, p. 690)
isolation
## Footnote
(Astle & Duggleby, 2024, p. 690)
166
ONLY IMPORTANT CARDS STARTING NOW
The effectiveness of infection-control practices depends on the nurse and their colleagues’ conscientiousness and consistency in using effective ___ technique.
## Footnote
(Astle & Duggleby, 2024, p. 690)
aseptic
## Footnote
(Astle & Duggleby, 2024, p. 690)
167
It is easy to forget key procedural steps or, in a hurry, to take shortcuts that break ___ procedures.
However, a nurse’s failure to be meticulous places the patient at risk for an ___ that can seriously impair recovery or lead to death.
## Footnote
(Astle & Duggleby, 2024, p. 690)
aseptic
infection
## Footnote
(Astle & Duggleby, 2024, p. 690)
168
Proper ___, ___, and ___ of contaminated objects significantly reduce and often eliminate microorganisms.
## Footnote
(Astle & Duggleby, 2024, p. 690)
cleaning
disinfection
sterilization
## Footnote
(Astle & Duggleby, 2024, p. 690)
169
___ is the physical removal of foreign material (e.g., dust, soil, and organic material such as blood, secretions, excretions, and microorganisms) from objects and surfaces.
## Footnote
(Joint Commission, 2019; Provincial Infectious Diseases Advisory Committee [PIDAC], 2018 as cited in Astle & Duggleby, 2024, p. 691)
Cleaning
## Footnote
(Joint Commission, 2019; Provincial Infectious Diseases Advisory Committee [PIDAC], 2018 as cited in Astle & Duggleby, 2024, p. 691)
170
In general, ___ involves the use of water and mechanical action with detergents or enzymatic products.
## Footnote
(Astle & Duggleby, 2024, p. 691)
cleaning
## Footnote
(Astle & Duggleby, 2024, p. 691)
171
When an object comes in contact with infectious or potentially infectious material, the object is ___.
## Footnote
(Astle & Duggleby, 2024, p. 691)
contaminated
## Footnote
(Astle & Duggleby, 2024, p. 691)
172
Reusable objects must be ___ thoroughly before reuse and then either ___ or ___ according to the manufacturer’s recommendations.
## Footnote
(Astle & Duggleby, 2024, p. 691)
cleaned
disinfected
sterilized
## Footnote
(Astle & Duggleby, 2024, p. 691)
173
When cleaning equipment that is soiled by organic material such as blood, fecal matter, mucus, or pus, nurses should take appropriate measures to protect themselves against contamination.
These may include wearing a ___ and protective ___ (or a ___ ___) and waterproof ___.
These barriers provide protection from infectious organisms.
## Footnote
(Astle & Duggleby, 2024, p. 691)
mask
eyewear, face shield
gloves
## Footnote
(Astle & Duggleby, 2024, p. 691)
174
A brush and detergent or soap are needed for ___.
## Footnote
(Astle & Duggleby, 2024, p. 691)
cleaning
## Footnote
(Astle & Duggleby, 2024, p. 691)
175
The following steps ensure that an object is clean:
1. Rinse a contaminated object or article with ___ running water to remove organic material.
___ water causes the protein in organic material to coagulate and stick to objects, making removal difficult.
2. After rinsing, wash the object with ___ and ___ water.
___ or ___ reduces the surface tension of water and emulsifies the dirt or remaining material.
Rinse the object thoroughly to remove the emulsified dirt.
3. Use a ___ to remove dirt or material in grooves or seams.
Friction dislodges the contaminated material for easy removal.
Open any hinged items for cleaning.
4. Rinse the object in ___ water.
5. ___ the object and prepare it for disinfection or sterilization if indicated by the intended use of the item.
6. The brush, gloves, and sink in which the equipment is cleaned should be considered ___ and should be cleaned and dried.
## Footnote
(Astle & Duggleby, 2024, p. 691)
cold
Hot
soap, warm
Soap, detergent
brush
warm
Dry
contaminated
## Footnote
(Astle & Duggleby, 2024, p. 691)
176
___ is the elimination of all pathogens except bacterial spores.
## Footnote
(Joint Commission, 2019; PIDAC, 2018 as cited in Astle & Duggleby, 2024, p. 691)
Disinfection
## Footnote
(Joint Commission, 2019; PIDAC, 2018 as cited in Astle & Duggleby, 2024, p. 691)
177
___ are used on inanimate objects; ___ are used on living tissue.
## Footnote
(Astle & Duggleby, 2024, p. 691)
Disinfectants
antiseptics
## Footnote
(Astle & Duggleby, 2024, p. 691)
178
___ usually involves chemicals, heat, or ultraviolet light.
## Footnote
(Astle & Duggleby, 2024, p. 691)
Disinfection
## Footnote
(Astle & Duggleby, 2024, p. 691)
179
An item must be thoroughly ___ before it is disinfected.
## Footnote
(Astle & Duggleby, 2024, p. 691)
cleaned
## Footnote
(Astle & Duggleby, 2024, p. 691)
180
Examples of ___ are alcohols, chlorines, glutaraldehydes, phenols, and quaternary ammonium compounds.
These chemicals can be caustic and toxic to tissues.
## Footnote
(Astle & Duggleby, 2024, p. 691)
disinfectants
## Footnote
(Astle & Duggleby, 2024, p. 691)
181
Some ___ are indicated for use only on noncritical items; nurses should read the label and follow the manufacturer’s recommendations for use.
## Footnote
(Astle & Duggleby, 2024, p. 691)
disinfectants
## Footnote
(Astle & Duggleby, 2024, p. 691)
182
Edit / Fix Placement
## Footnote
(Astle & Duggleby, 2024, p. 691)
## Footnote
(Astle & Duggleby, 2024, p. 691)
183
___ is the destruction of all microorganisms, including spores.
## Footnote
(Astle & Duggleby, 2024, p. 691)
Sterilization
## Footnote
(Astle & Duggleby, 2024, p. 691)
184
Steam under pressure, ethylene oxide gas, hydrogen peroxide plasma, and chemicals are the most common ___ agents.
## Footnote
(Astle & Duggleby, 2024, p. 691)
sterilizing
## Footnote
(Astle & Duggleby, 2024, p. 691)
185
Items must be ___ thoroughly before they can be sterilized.
## Footnote
(Astle & Duggleby, 2024, p. 691)
cleaned
## Footnote
(Astle & Duggleby, 2024, p. 691)
186
Efficacy of the disinfecting or sterilizing method is influenced by the following factors:
* ___ of solution and ___ of contact.
* Type and number of ___.
* ___ ___ to treat.
* ___ of the environment.
* Presence of ___.
* Presence of ___ ___.
## Footnote
(Astle & Duggleby, 2024, p. 691)
Concentration, duration
pathogens
Surface areas
Temperature
organic materials
## Footnote
(Astle & Duggleby, 2024, p. 691)
187
Certain organisms are killed more easily than others by disruption.
Higher numbers of ___ on an object necessitate longer disinfecting time.
## Footnote
(Astle & Duggleby, 2024, p. 691)
pathogens
## Footnote
(Astle & Duggleby, 2024, p. 691)
188
___ tend to work best at room temperature.
## Footnote
(Astle & Duggleby, 2024, p. 691)
Disinfectants
## Footnote
(Astle & Duggleby, 2024, p. 691)
189
___ may cause certain disinfectants to be ineffective.
## Footnote
(Astle & Duggleby, 2024, p. 691)
Soap
## Footnote
(Astle & Duggleby, 2024, p. 691)
190
___ can become inactivated unless blood, saliva, pus, or body excretions are already washed off.
## Footnote
(Astle & Duggleby, 2024, p. 691)
Disinfectants
## Footnote
(Astle & Duggleby, 2024, p. 691)
191
Selection of the method for disinfecting or sterilizing an item depends on the intended ___ and nature of the item (e.g., some delicate instruments cannot tolerate steam and must be sterilized with gas or plasma).
## Footnote
(Astle & Duggleby, 2024, p. 691)
use
## Footnote
(Astle & Duggleby, 2024, p. 691)
192
EDIT AND FIX PLACEMENT?
## Footnote
(Astle & Duggleby, 2024, p. 691)
## Footnote
(Astle & Duggleby, 2024, p. 691)
193
To control or eliminate ___ sites for infection, nurses need to eliminate or control sources of body fluids, drainage, or solutions that might harbour microorganisms.
Nurses must also carefully discard articles that become contaminated with infectious material.
## Footnote
(Astle & Duggleby, 2024, p. 692)
reservoir
## Footnote
(Astle & Duggleby, 2024, p. 692)
194
All health care institutions must have guidelines for the disposal of ___ ___ according to provincial or territorial laws.
## Footnote
(Astle & Duggleby, 2024, p. 692)
infectious waste
## Footnote
(Astle & Duggleby, 2024, p. 692)
195
To control organisms exiting via the respiratory tract, the nurse should wear a ___ as needed, avoid talking directly into patients’ faces, and never talk, sneeze, or cough directly over surgical wounds or sterile dressing fields.
The nurse should cover the mouth or nose when ___ or ___.
Nurses are also responsible for teaching patients to protect others when they ___ or ___ and for providing patients with disposable wipes or tissues to control the spread of microorganisms.
## Footnote
(Astle & Duggleby, 2024, p. 692)
mask
sneezing, coughing
sneeze, cough
## Footnote
(Astle & Duggleby, 2024, p. 692)
196
Nurses who have an ___ ___ ___ infection should consider not working; they may be required to remain at home.
Nurses who continue to work with patients should wear a ___ when working closely with a patient and pay special attention to ___ ___.
Nurses should not be caring for patients who are highly ___ to infection (e.g., an immunosuppressed patient or a newborn).
## Footnote
(Astle & Duggleby, 2024, p. 692)
upper respiratory tract
mask, hand hygiene
susceptible
## Footnote
(Astle & Duggleby, 2024, p. 692)
197
Another way of controlling the exit of microorganisms is through the careful handling of blood, body fluids, secretions, or excretions (e.g., urine, feces, vomitus, and exudate).
___ fluids can easily splash while being discarded or cleaned up.
Nurses should always wear ___ ___ when handling blood, body fluids, secretions, or excretions.
___, ___, and protective ___ should be worn if splashing or contact with any fluids is possible.
Disposable soiled items should be appropriately disposed of in impervious plastic bags.
## Footnote
(Astle & Duggleby, 2024, p. 692)
Contaminated
disposable gloves
Masks, gowns, eyewear
## Footnote
(Astle & Duggleby, 2024, p. 692)
198
Laboratory specimens from all patients are handled as if they were ___.
## Footnote
(Astle & Duggleby, 2024, p. 692)
infectious
## Footnote
(Astle & Duggleby, 2024, p. 692)
199
Edit, etc.
## Footnote
(Astle & Duggleby, 2024, p. 692)
## Footnote
(Astle & Duggleby, 2024, p. 692)
200
Effective control of infection requires nurses to remain aware of the modes of ___ and ways to control them.
## Footnote
(Astle & Duggleby, 2024, p. 693)
transmission
## Footnote
(Astle & Duggleby, 2024, p. 693)
201
In the hospital, home, or long-term care facility, a patient should have a ___ set of care items.
The sharing of bedpans, urinals, bath basins, and eating utensils can easily lead to transmission of infection.
## Footnote
(Astle & Duggleby, 2024, p. 693)
personal
## Footnote
(Astle & Duggleby, 2024, p. 693)
202
___, even when individually used, warrant special care.
## Footnote
(Astle & Duggleby, 2024, p. 693)
Thermometers
## Footnote
(Astle & Duggleby, 2024, p. 693)
203
Because the patient’s own mucus can become a source of microorganism growth, the electronic ___ is used with a disposable sheath over the probe; the sheath is discarded after each use.
## Footnote
(Astle & Duggleby, 2024, p. 693)
thermometer
## Footnote
(Astle & Duggleby, 2024, p. 693)
204
Single-use chemical strip ___ present less risk of infection than do other ___.
## Footnote
(Astle & Duggleby, 2024, p. 693)
thermometers x 2
## Footnote
(Astle & Duggleby, 2024, p. 693)
205
Use of electronic thermometers for rectal temperatures has been associated with ___ ___.
## Footnote
(Centers for Disease Control and Prevention, 2019a as cited in Astle & Duggleby, 2024, p. 693)
nosocomial diarrhea
## Footnote
(Centers for Disease Control and Prevention, 2019a as cited in Astle & Duggleby, 2024, p. 693)
206
The organism ___ ___ (___. ___) is able to survive on inanimate surfaces such as a thermometer probe for weeks to months.
## Footnote
(Astle & Duggleby, 2024, p. 693)
Clostridioides difficile (**C**. **difficile**)
## Footnote
(Astle & Duggleby, 2024, p. 693)
207
In institutions where ___ ___ occurs, electronic thermometers are not recommended for taking rectal temperatures.
## Footnote
(Astle & Duggleby, 2024, p. 693)
nosocomial diarrhea
## Footnote
(Astle & Duggleby, 2024, p. 693)
208
To prevent transmission of microorganisms through indirect contact, soiled items and equipment must not touch the nurse’s ___.
A common error is to carry dirty linen in one’s arms against the ___.
___-resistant linen bags should be used, or soiled linen should be carried with hands held out from the body.
Laundry hampers should be replaced before they are ___.
## Footnote
(Astle & Duggleby, 2024, p. 693)
clothing
uniform
Fluid
overflowing
## Footnote
(Astle & Duggleby, 2024, p. 693)
209
Many measures that control the exit of microorganisms likewise control their entrance.
Maintaining the integrity of ___ and ___ ___ reduces the chances of microorganisms reaching a host.
The patient’s skin should be kept well lubricated by using ___ as appropriate.
Immobilized and debilitated patients are particularly susceptible to skin ___.
Patients should not be positioned on tubes or objects that might cause breaks in the skin.
Dry, wrinkle-free ___ also reduces the chances of skin breakdown.
Frequent ___ and ___ are needed in order to prevent a patient’s skin from becoming reddened.
Frequent oral hygiene prevents the drying of ___ ___.
A ___-soluble ointment keeps the patient’s lips well lubricated.
## Footnote
(Astle & Duggleby, 2024, p. 697)
skin, mucous membranes
lotion
breakdown
linen
turning, positioning
mucous membranes
water
## Footnote
(Astle & Duggleby, 2024, p. 697)
210
After elimination, a person with female genitalia should clean the rectum and perineum by wiping from the urinary ___ toward the ___.
Cleansing in a direction from the least to the most contaminated area helps reduce genitourinary infections.
Meticulous and frequent perineal care is especially important in persons who wear ___ pads.
## Footnote
(Astle & Duggleby, 2024, p. 697)
meatus
rectum
incontinence
## Footnote
(Astle & Duggleby, 2024, p. 697)
211
Patients, health care workers, and even housekeepers are at risk for acquiring infections from accidental needle sticks.
After administering an injection or inserting an intravenous catheter, the nurse should engage any safety device and carefully dispose of needles in a ___-resistant box.
## Footnote
(Astle & Duggleby, 2024, p. 697)
puncture
## Footnote
(Astle & Duggleby, 2024, p. 697)
212
A stray needle lying in the bed linen or carelessly thrown into a wastebasket is a prime source of exposure to ___ pathogens.
## Footnote
(Astle & Duggleby, 2024, p. 697)
bloodborne
## Footnote
(Astle & Duggleby, 2024, p. 697)
213
___ ___ and ___ are the infections most commonly transmitted by contaminated needles.
## Footnote
(Astle & Duggleby, 2024, p. 697)
Hepatitis B, C
## Footnote
(Astle & Duggleby, 2024, p. 697)
214
A needle stick should be ___ immediately.
## Footnote
(Astle & Duggleby, 2024, p. 697)
reported
## Footnote
(Astle & Duggleby, 2024, p. 697)
215
Health care agencies require the victim of a needle stick to complete an ___ ___ and seek appropriate treatment.
## Footnote
(Astle & Duggleby, 2024, p. 697)
injury report
## Footnote
(Astle & Duggleby, 2024, p. 697)
216
The ___ ___ ___ ___ ___ has the mandate to monitor health care workers exposed to needle sticks and the subsequent outcomes of these exposures.
## Footnote
[Public Health Agengy of Canada (PHAC), 2020b as cited in Astle & Duggleby, 2024, p. 697]
Canadian Needle Stick Surveillance Network
## Footnote
(Astle & Duggleby, 2024, p. 697)
217
Another cause of microorganism entrance into a host is improper handling and management of urinary catheters and drainage sets.
The point of connection between a ___ and ___ ___ should remain closed and intact.
As long as such systems are closed, their contents are considered ___.
Outflow spigots on ___ ___ should also remain closed to prevent the entrance of bacteria.
Movement of the ___ at the urethra should be minimized by stabilizing the ___ with tape to reduce chances of microorganisms ascending the urethra into the bladder.
Urine-___ containers should not be shared between patients.
## Footnote
(Astle & Duggleby, 2024, p. 697)
catheter, drainage tube
sterile
drainage bags
catheter x 2
measuring
## Footnote
(Astle & Duggleby, 2024, p. 697)
218
Nurses may care for patients with closed drainage systems that collect wound drainage, bile, or other body fluids.
In each example, the site from which a drainage tube exits should remain clear of excess ___ and accumulated drainage.
All tubing should remain connected throughout use.
Drainage ___ should be opened only when it is necessary to discard or measure the volume of drainage.
## Footnote
(Astle & Duggleby, 2024, p. 697)
moisture
receptacles
## Footnote
(Astle & Duggleby, 2024, p. 697)
219
At times, nurses will obtain ___ from drainage tubes or intravenous tubing ports.
First, the nurse must perform hand hygiene; then tubes and ports are ___ by wiping the surface outward with alcohol, iodine, or a chlorhexidine alcohol solution before entering the system.
Temporarily placing squares of sterile ___ around the ends of an open drainage tube, such as a urinary catheter, adds further protection against bacteria.
However, keeping drainage tubes ___ and secure is the best practice.
## Footnote
(Astle & Duggleby, 2024, p. 697)
specimens
disinfected
gauze
closed
## Footnote
(Astle & Duggleby, 2024, p. 697)
220
A final method for reducing the entrance of microorganisms is the technique for cleansing wounds.
A surgical wound is considered to be ___.
## Footnote
(Astle & Duggleby, 2024, p. 697)
sterile
## Footnote
(Astle & Duggleby, 2024, p. 697)
221
To prevent the entrance of microorganisms into the wound, clean (inward/outward) from a wound site.
When applying an antiseptic or cleaning with soap and water, wipe around the wound edge first and then clean (inward/outward) away from the wound.
Clean gauze should be used for each ___ around the wound’s circumference.
## Footnote
(Astle & Duggleby, 2024, p. 697)
outward
outward
revolution
## Footnote
(Astle & Duggleby, 2024, p. 697)
222
Patients’ resistance to infection improves as nurses protect patients’ normal body ___ against infection.
## Footnote
(Astle & Duggleby, 2024, p. 698)
defences
## Footnote
(Astle & Duggleby, 2024, p. 698)
223
Nurses can intervene to maintain the body’s normal reparative processes.
Nurses must also protect themselves and others by following their agency’s ___ guidelines.
## Footnote
(Astle & Duggleby, 2024, p. 698)
isolation
## Footnote
(Astle & Duggleby, 2024, p. 698)
224
Match each action taken to 'Protect the Susceptible Host' with its corresponding category:
Category (1-2)
1. Protecting Normal Defence Mechanisms
2. Maintaining Healing Processes
Actions (A-H)
A) For physically dependent or immobilized patients, nurses should encourage routine coughing and deep breathing to keep patients’ lower airways clear of mucus.
B) Nurses can assist a patient in learning techniques to reduce stress.
C) Regular bathing removes transient microorganisms from the skin’s surface. Lubrication helps keep the skin hydrated and intact.
D) Nurses should encourage proper immunization of children and adult patients.
E) Maintenance of adequate fluid intake promotes normal urine formation and a resultant outflow of urine to flush the bladder and urethral lining of microorganisms.
F) Regular oral hygiene removes proteins in the saliva that attract microorganisms. Flossing removes tartar and plaque that can cause infection.
G) A patient’s comfort and sleep need to be promoted, as both are vital to replenishing energy stores on a daily basis.
H) Nurses need to encourage the intake of adequate fluids and a well-balanced diet containing essential proteins, vitamins, carbohydrates, and fats. Nurses should also use measures to increase the patient’s appetite.
## Footnote
(Astle & Duggleby, 2024, p. 698)
1. C, F, E, A, and D
2. H, G, and B
## Footnote
(Astle & Duggleby, 2024, p. 698)
225
The risk of transmitting an ___ ___-___ ___ (___) or infectious disease among patients is high.
## Footnote
(Astle & Duggleby, 2024, p. 698)
**health care**-**associated infection** (**HAI**)
## Footnote
(Astle & Duggleby, 2024, p. 698)
226
When a patient has a suspected or known infection, health care workers are alerted and follow infection control practices.
However, sometimes health care workers are not aware that patients have infections.
The majority of organisms causing ___ infections are found in the colonized body substances of patients regardless of whether a culture has confirmed infection and a diagnosis has been made.
## Footnote
[Centers for Disease Control (CDC), 2019d as cited in Astle & Duggleby, 2024, p. 698]
nosocomial
## Footnote
[Centers for Disease Control (CDC), 2019d as cited in Astle & Duggleby, 2024, p. 698]
227
Body substances such as feces, saliva, mucus, and wound drainage always contain potentially ___ organisms.
## Footnote
(Astle & Duggleby, 2024, p. 698)
infectious
## Footnote
(Astle & Duggleby, 2024, p. 698)
228
The Center for Disease Control (CDC) issued ___ guidelines in 1996 that contain a two-tiered approach.
These guidelines were updated and expanded in 2007 and have been adopted by most health care agencies.
Some health care agencies have adopted Public Health Agency of Canada’s (PHAC) isolation guidelines, which contain a similar two-tiered approach.
## Footnote
[Garner, 1996; Public Health Agency of Canada’s (PHAC), 2017 as cited in Astle & Duggleby, 2024, p. 698]
isolation
## Footnote
[Garner, 1996; Public Health Agency of Canada’s (PHAC), 2017 as cited in Astle & Duggleby, 2024, p. 698]
229
The ___ ___ ___ of ___ guidelines were written to accommodate acute, long-term, home, and ambulatory care settings, whereas the ___ for ___ ___ (___) guidelines were written specifically for acute care settings.
Nevertheless, the ___ for ___ ___ (___) guidelines and ___ ___ ___ of ___ (___) guidelines are essentially interchangeable.
## Footnote
(Astle & Duggleby, 2024, p. 698)
**Public Health Agency** of **Canada** (**PHAC**) (**PHAC**), **Center** for **Disease Control** (**CDC**)
**Center** for **Disease Control** (**CDC**), **Public Health Agency** of **Canada** (**PHAC**)
## Footnote
(Astle & Duggleby, 2024, p. 698)
230
The first tier of the isolation guidelines contains practices designed to care for all patients in any setting, regardless of their diagnosis or presumed infectiousness.
In the Public Health Agency of Canada’s (PHAC) guidelines, it is called ___ ___.
## Footnote
(Astle & Duggleby, 2024, p. 698)
routine practices
## Footnote
(Astle & Duggleby, 2024, p. 698)
231
Routine practices apply when a health care worker is or potentially may be exposed to (1) ___; (2) all ___ ___, ___, and ___ except sweat; (3) ___ skin; or (4) ___ ___.
## Footnote
(Astle & Duggleby, 2024, p. 698)
blood
body fluids
secretions
excretion
nonintact
mucous membranes
## Footnote
(Astle & Duggleby, 2024, p. 698)
232
___ ___ include the appropriate use of gowns, gloves, masks, eyewear, and other protective devices or clothing.
Barrier protection is indicated for use with all patients because every patient has the potential to transmit infection via blood and body fluids, and the risk for infection transmission can be unknown.
## Footnote
(Astle & Duggleby, 2024, p. 698)
Routine practices
## Footnote
(Astle & Duggleby, 2024, p. 698)
233
___ ___ include rules on appropriate handwashing, cleaning of equipment, and disposal of contaminated linen and sharps.
## Footnote
(Astle & Duggleby, 2024, p. 698)
Routine practices
## Footnote
(Astle & Duggleby, 2024, p. 698)
234
The second tier of the isolation guidelines is ___ ___.
These precautions are designed to contain pathogens in one area, usually the patient’s room; therefore, they are often called isolation precautions.
## Footnote
(Astle & Duggleby, 2024, p. 698)
additional precautions
## Footnote
(Astle & Duggleby, 2024, p. 698)
235
Only patients infected or colonized with certain highly transmissible or epidemiologically significant pathogens are placed under ___ ___.
These precautions are followed in addition to routine practices.
## Footnote
(Astle & Duggleby, 2024, p. 698)
isolation precautions
## Footnote
(Astle & Duggleby, 2024, p. 698)
236
Isolation precautions are categorized in three ways: ___, ___, and ___ precautions.
The precautions used depend on how the pathogen is spread.
For example, a patient diagnosed with (or suspected of having) active tuberculosis (TB) would require the use of ___ precautions, using a special mask and ventilated room, in conjunction with routine practices.
## Footnote
(Astle & Duggleby, 2024, p. 698)
airborne
droplet
contact
airborne
## Footnote
(Astle & Duggleby, 2024, p. 698)
237
Regardless of the category of isolation precaution, nurses must observe the following basic principles:
* Observe thorough ___ ___ before entering and leaving the room of a patient in isolation
* Dispose of contaminated supplies and equipment in a manner that prevents the spread of microorganisms to other persons as indicated by the mode of ___ of the organism
* Apply knowledge of a disease process and the mode of infection ___ when using protective barriers
* Ensure that all persons who might be exposed during ___ of a patient outside the isolation room are protected
## Footnote
(Astle & Duggleby, 2024, p. 698)
hand hygiene
transmission
transmission
transport
## Footnote
(Astle & Duggleby, 2024, p. 698)
238
A patient required to be in ___ in a private room may become lonely because normal social relationships are disrupted. This situation can be psychologically harmful, especially for children.
## Footnote
(Astle & Duggleby, 2024, p. 698)
isolation
## Footnote
(Astle & Duggleby, 2024, p. 698)
239
Patients’ body image may be altered as a result of the infectious process.
Patients may feel unclean, rejected, lonely, or guilty.
Infection prevention and control practices further intensify these feelings of difference or undesirability.
___ in a private room limits sensory contact.
Unless nurses act to minimize feelings of psychological and physical ___, patients’ emotional state can interfere with their recovery.
## Footnote
(Astle & Duggleby, 2024, p. 698)
Isolation
isolation
## Footnote
(Astle & Duggleby, 2024, p. 698)
240
Before ___ measures are instituted, a patient and family must understand the nature of the disease or condition, purposes of ___, and steps for carrying out specific precautions.
If they are able to participate in maintaining infection prevention, the chances of reducing the spread of infection are increased.
The patient and family should be taught to perform ___ ___ and use ___ protection if appropriate.
Each procedure should be demonstrated, and the patient and family should be given an opportunity to practise it.
It is also important to explain how infectious organisms can be ___ so that the patient understands the difference between contaminated and clean objects.
## Footnote
(Astle & Duggleby, 2024, p. 698)
isolation x2
hand hygiene, barrier
transmitted
## Footnote
(Astle & Duggleby, 2024, p. 698)
241
Nurses should take measures to improve the patient’s sensory stimulation during ___.
The room environment should be clean and pleasant.
Drapes or shades should be (closed/opened), and excess supplies and equipment removed.
Nurses must listen to the patient’s concerns or interests.
If the nurse hurries through care or shows a lack of interest, the patient will feel rejected and even more ___.
___ is a particularly good opportunity for conversation.
Providing comfort measures such as repositioning, a back massage, or a tepid sponge bath increases physical stimulation.
If appropriate for the patient’s condition, the nurse should encourage the patient to walk and to sit up in a chair.
Recreational activities such as board games or cards may be an option to keep the patient mentally stimulated.
## Footnote
(Astle & Duggleby, 2024, p. 698)
isolation
opened
isolated
Mealtime
## Footnote
(Astle & Duggleby, 2024, p. 698)
242
Public Health Agency of Canada (PHAC) Routine Practices and Additional Precautions
___ ___ and precautions are for the care of all patients; they incorporate previous precautions against bloodborne pathogens (universal precautions) and body substance isolation.
Hand hygiene must be performed before and after ___ patient contact; before and after contact with the patient’s ___; after contact with ___, ___ ___, ___, and ___ and after contact with equipment or articles contaminated by them; and before ___ are put on and immediately after ___are removed. Refer to the agency’s policy for use of alcohol-based waterless ___.
Gloves are worn when touching ___, ___ ___, ___, ___, ___ skin, ___ ___, or ___ items. Gloves should be removed and ___ ___ performed between care of patients. Gloves should also be changed and ___ ___ performed between procedures on the same patient and after contact with material that may be highly contaminated.
Masks, eye protection, or face shields are worn if patient care activities or procedures may generate splashes or sprays of blood or body fluid or by ___ transmission.
___ should be used to protect uncovered skin and prevent soiling of clothing during procedures and patient care activities likely to generate a splash or spray of blood or body fluid. Reusable patient care equipment is properly cleaned and reprocessed before use in the care of another patient. Single-use items are discarded. All soiled linen from health care facilities should be handled the same way for all patients. If the bag ___ through, an additional bag should be used. Used sharp instruments and needles are discarded in a ___-resistant container, which is located in the area where the item is used.
Generally, a ___ room is unnecessary for routine patient care. Patients who visibly soil the environment or for whom appropriate hygiene cannot be maintained should be placed in a single room with dedicated toileting facilities.
## Footnote
(Astle & Duggleby, 2024, p. 698)
Routine practices
direct, environment, blood, body fluids, secretions, excretions, gloves x 2, antiseptics
blood, body fluids, secretions, excretions, nonintact, mucous membranes, contaminated, hand hygiene x 2
droplet
Gowns, soaks, puncture
single x 2
## Footnote
(Astle & Duggleby, 2024, p. 698)
243
Match the additional (isolation) precautions (tier two) with their corresponsing description and disease and barrier protection.
Additional (Isolation) Precautions (Tier Two) (1-3)
1. Airborne Precautions
2. Droplet Precautions
3. Contact Precautions
Description and Disease (A-C)
A) For known or suspected infections caused by microbes transmitted by droplets produced by measles, chicken pox (varicella), disseminated zoster, tuberculosis.
B) For known or suspected infections caused by direct or indirect contact with colonization or infection with multidrug-resistant organisms; C. difficile; major wound infections; gastrointestinal, respiratory, or skin infections.
C) For known or suspected infections caused by microbes transmitted by droplets produced by coughing, sneezing, or talking; examples: diphtheria (pharyngeal), rubella, influenza, pertussis, mumps, meningococcal pneumonia, coronavirus, sepsis.
Barrier Protection (I - III)
I Private room (room door kept closed), negative-pressure airflow of at least six exchanges per hour, respiratory protection device (e.g., N95 respirator) must be worn when the patient has tuberculosis or when the patient has varicella, disseminated zoster, or measles and the worker is not immune.
II Private room or cohort patients (door can be open); gloves and gown upon entry into isolation room; limiting patient movement outside isolation room to necessary medical treatments or procedures; cleaning and disinfecting or discarding items before removal from isolation room.
III Private room or cohort patients (room door closed unless bed is more than 2 m from the door), mask is worn when within 2 m of the patient.
## Footnote
(Canadian Center for Occupational Health and Safety, 2021; Antibiotic Resistance., 2007 as cited in Astle & Duggleby, 2024, pp. 699, 700)
1. A, I
2. C, III
3. B, II
## Footnote
(Canadian Center for Occupational Health and Safety, 2021; Antibiotic Resistance., 2007 as cited in Astle & Duggleby, 2024, pp. 699, 700)
244
Nurses must explain to the family the patient’s risk for depression or loneliness.
Visiting family members should be taught the principles of ___ and encouraged to avoid expressions or actions that convey revulsion, fear, or disgust.
Ways to provide meaningful stimulation should also be discussed.
## Footnote
(Astle & Duggleby, 2024, p. 700)
isolation
## Footnote
(Astle & Duggleby, 2024, p. 700)
