Lecture 11 Flashcards
Client safety and Infection Control
1
Q
What vulnerable groups need help in achieving a safe environment?
A
- Children
- Older Adults
- The Ill
- The Physically and Mentally Disabled
- The Illiterate
- The Poor
2
Q
A patient’s environment includes…
A
physical and psychosocial factors that influence or affect the life and survival of that patient
3
Q
what protects the staff and allows them to function properly?
A
A safe environment
4
Q
What is one environmental factor that could decrease the amount of available oxygen when not in a healthcare setting?
A
Carbon Monoxide
5
Q
Who regulates commercially processed and packed foods?
A
the FDA
6
Q
Who is at higher risk for hypothermia?
A
- Older Adults
- Young People
- Patients who are intoxicated on drugs or alcohol
- The Homeless
7
Q
Temperature extremes that often occur in the winter and summer affect what?
A
- Comfort
- productivity
- safety
8
Q
What is a pathogen?
A
Any microorganism that is capable of producing illness
9
Q
What is the most common mode of transportation of pathogens?
A
The hands
10
Q
What is one of the most effective methods for limiting the transmission of pathogens?
A
Hand hygiene
11
Q
How is HIV, AIDS, and Hep B transmitted?
A
Through blood and other body select bodily fluid
12
Q
Immunization does what?
A
it can reduce or prevent the transmission of disease from person to person
13
Q
True or False: As a nurse you are responsible for educating patients about the benefits of immunization.
A
T
14
Q
What is a pollutant?
A
A harmful chemical or waste material that is discharged into the water, air, or soil
15
Q
In the home, school, or workplace, what is the primary cause of air pollution?
A
Cigarette smoke
16
Q
what type of pollutant is typically found in water pollution?
A
Industrial pollutants
17
Q
Describe physical hazards in the environment.
A
Physical hazards in the environment threaten a persons safety and often results in physical or psychological injury or death
18
Q
What are some examples of physical hazards (5)?
A
Hazards associated with:
1) Motor Vehicle Accidents
2) Poison
3) Falls
4) Fires
5) Disasters
19
Q
What are the leading cause of death for americans of all ages?
A
Accidents are the leading cause of death followed by poisonings and falls
20
Q
Child safety and booster seats should be used…
A
At all times
21
Q
A poison is…
A
Any substance that impairs health or destroys life when ingested, inhaled, or absorbed by the body
22
Q
Almost any substance is (BLANK) if too much is taken.
A
poisonous
23
Q
What are some sources of potential poisoning in a person’s home (5)?
A
1) Drugs
2) Medicines
3) Solid and liquid chemicals
4) Gases
5) Vapors
24
Q
Which organ system can poisons affect?
A
Every major organ system
25
what is the best resource for patients and parents needing info on treatment of accidental poisonings?
Poison control centers
26
What is the leading cause of both fatal and non-fatal injuries in people 65 and older?
Falls
27
what kinds of factors increase the risk of falling(8)?
1) Being 65 or older
2) Reduced vision
3) Orthostatic hypotension
4) Leg weakness
5) Gait and balance problems
6) Urinary incontinence
7) Improper use of walking aids
8) Medications
28
What is the leading cause of fire-related death?
Careless smoking, especially when people smoke in bed at home.
29
where should multipurpose fire extinguishers be located?
Near the kitchen and any workshop area
30
what should nurses advise patients concerning space heaters?
to purchase newer-model space heaters that have safety features
31
What is bioterrorism considered?
A cause of disaster
32
While caring for a child, you identify that additional safety teaching is needed when a young and inexperienced mother states that:
A. teenagers need to practice safe sex.
B. a 3-year-old can safely sit in the front seat of the car.
C. children need to wear safety equipment when bike riding.
D. children need to learn to swim even if they do not have a pool.
B
33
Apart from physical safety risk, what factors influence patient safety(4)?
1) Patient's developmental level
2) Mobility, sensory, and cognitive status
3) lifestyle choices
4) Knowledge of common safety precautions
34
What are the greatest risks for children younger than 5 years old(7)?
Home accidents including:
1) Poisoning
2) Choking
3) Fires started by playing with fire
4) Falls
5) Unrestrained car riding
6) Drowning
7) Head trauma
35
Accident prevention for children less than five includes
Health education for parents and removal of dangers whenever possible
36
Where are school-aged children most at risk for injury(3)?
1) Home
2) School
3) While traveling to and from school
37
What should be taught to school aged children to reduce risk for injury(3)?
1) Stranger danger
2) Sports safety
3) Use of safety equipment especially bike helmets
38
What are adolescents most at risk for injury due to(3)? Why?
1) Auto accidents
2) Suicide
3) Substance abuse
Because they engage in risk-taking behavior
39
Threats to an adult's safety are frequently associated with...
Lifestyle habits (Smoking, Drinking, Hazardous work, etc.)
40
Risks for injury for older adults are directly related to what(3)?
The physiological changes of the aging process including:
1) Effects of multiple meds
2) Psychological and cognitive factors
3) Effects of chronic and acute disease
41
What are the **individual risk factors** for injury(4)?
LISL
1) Lifestyle
2) Impaired mobility
3) Sensory or communication impairment
4) Lack of safety awareness
42
People experiencing stress, Anxiety, fatigue, alcohol or drug withdrawal, or those taking prescription meds are sometimes more prone to what?
Accidents
43
Patients with delirium, dementia, and depression become easily confused with their surroundings and are more likely to have...
Falls and burns
44
Why are people with visual, hearing, tactile, or communication impairment such as aphasia or a language barrier at an increased danger risk?
Because they are not always able to perceive potential danger or express their need for assistance
45
A nursing assessment that includes a home inspection helps you to identify...
A patients level of knowledge about home safety so you can correct deficiencies with an individualized nursing care plan
46
Medical errors happen when...
something that was planned as part of medical care doesn't work out or the wrong plan was used. They occur in all health care settings.
47
* Building consensus on national priorities and goals for performance improvement and working in partnership to achieve them;
* Endorsing national consensus standards for measuring and publicly reporting on performance; and
* Promoting the attainment of national goals through education and outreach programs.
These are whose methods of improving healthcare in America?
The National Quality Forum (NQF)
48
The Joint Commission (TJC) and the Centers for Medicare and Medicaid (CMS) emphasize error prevention and patient safety. Their "Speak up" campaign...
Encourages patients to take a role in preventing healthcare errors by becoming active, involved, and informed participants on the health care team
49
When does a nurse or HCP complete an incident or occurrence report?
When an actual or potential adverse event occurs
50
What are some environmental risks that nurses face(4)?
CACD
1) Chemicals found in some medication (e.g. Chemotherapy)
2) Anesthetic drugs
3) Cleaning solutions
4) Disinfectants
51
What are the specific risks to a patient's safety within the healthcare environment(4)?
1) Falls
2) Patient-inherent accidents
3) Procedure-related accidents
4) Equipment related accidents
52
What are Patient-inherent accidents?
Accidents classified as self-induced
**Need to figure out whether accident was caused by seizure activity**
53
What are procedure-related accidents?
Accidents that occur during therapy
54
What are some Procedure-related accidents(4)?
MIII
1) Medication administration errors
2) IV therapy errors
3) Improper application of external devices
4) Improper performance of procedures
55
What technique is used for sterile dressing changes or invasive procedures such as foley catheter insertion?
Sterile technique
56
What are equipment-related accidents?
Accidents that result from Malfunction, disrepair, or misuse of equipment, or from an electrical hazard
57
How can you avoid equipment-related accidents?
Make sure equipment has been well maintained and has undergone safety inspection. also make sure you know how to use something before you use it
58
Facilities must report all suspected medical device-related deaths to who?
Both the FDA and manufacturer of the product if known
59
You are caring for a patient who underwent surgery 48 hours ago. On physical assessment, you notice that the wound looks red and swollen. The patient’s WBCs are elevated. You should:
A. start antibiotics.
B. notify the provider.
C. document the findings and reassess in 2 hours.
D. place the patient on isolation precautions.
B
60
A patient is admitted to a medical unit for a home-acquired pressure ulcer. The patient has Alzheimer’s disease and has been incontinent of urine. The nurse inserts a Foley catheter. You will identify a link in the infection chain as:
A. restraints.
B. poor hygiene.
C. Foley catheter bag.
D. improper positioning.
C
61
A nurse floats to a busy surgical unit and administers a wrong medication to a patient. This error can be classified as:
A. a poisoning accident.
B. an equipment-related accident.
C. a procedure-related accident.
D. an accident related to time management.
C
62
A newly admitted patient was found wandering the hallways for the past two nights. The most appropriate nursing interventions to prevent a fall for this patient would include:
A. raise all four side rails when darkness falls.
B. use an electronic bed monitoring device.
C. place the patient in a room close to the nursing station.
D. use a loose-fitting vest-type jacket restraint.
B
63
When assessing a patient, consider possible threats to the patient's safety including...
Immediate environment and any individual risk factors
64
At a minimum, assessment of a patients risk factors for falling should be completed when(4)?
1) Admission
2) Following a change in condition
3) After a fall
4) After a transfer
65
Hospitals must be prepared to respond to a sudden influx of patients at the time of...
Community disaster
66
Early signs of bioterrorism-related illness often include...
Non-specific symptoms that may persist for several days before the onset of a more severe disease
67
How should a hazard assessment be conducted at a patient's home?
Walk through the home with the patient and discuss how he or she **normally conducts daily activities** and whether the **environment poses problems**
68
What should nurses help patients focus on when conducting a hazard assessment in a patient's home?
Help individuals focus on avoiding losses and reducing their risk for injury associated with disasters
69
what does a thorough hazard assessment cover(5)?
1) lighting
2) safety devices
3) furniture and other items
4) Condition of flooring
5) Safety in kitchen and bathrooms
70
What does assessing the patients risk for food infection include?
Assessing patient's knowledge of food prep and storage practices; also assess handwashing practices
71
Assessment of thee environmental comfort of a patients home includes review of...
when the patient normally has their heating and cooling systems services
72
When patients live in older homes, encourage them to have inspections for...
The presence of lead in the paint, dust, and soil
73
What are these?
*Risk for injury
* Contamination Exposure: Exposure to environmental contaminants at a level that can cause adverse health effects
* Presence of Lead-Based Paint: Presence of known lead-based paint in a dwelling
* Risk for Environmental Contamination: Increased risk for exposure to environmental contaminants at a level that can cause adverse health effects
**Risk of Poisoning Injury: Increased risk of injury from swallowing, inhaling, or having contact with a toxic substance
**Risk of Radiation Exposure: Increased risk of exposure to potentially hazardous levels of ionizing radiation
*Risk for Falls: Increased risk for falling
Nursing Clinical Problems for patients with safety risk
74
Planning involves...(3)
1) Establishing goals (Outcomes)
2) Setting priorities
3) Teamwork and collaboration
75
Your Goals (Outcomes) should...(3)
1) Prevent and minimize safety threats
2) Be measurable and realistic
3) include active patient participation (if appropriate)
76
Use (BLANK) to organize information for collaboration
SBAR
77
*The QSEN project (2014) outlines recommended skills to ensure nurse competency in patient safety: (3)
*Demonstrate effective use of technology and standardized practices that support safety and quality.
*Demonstrate effective use of strategies to reduce risk of harm to self or others.
*Use appropriate strategies to reduce reliance on memory.
78
Passive strategies to promote safe environments and lifestyles that minimizes the risk for injury include:
Public health and government legislative interventions
79
Active strategies to promote safe environments and lifestyles that minimizes the risk for injury include:
strategies in which an individual is actively involved through changes in lifestyle
80
What is a good way to reduce falls at the bedside?
Keep bedside environment free of clutter and explain how to use the call light
81
what do yellow wrist bands mean?
fall risk
82
A patient in a wheel chair is most at risk for a fall during which times?
During transferring and reaching while seated
83
When patients use assistive aids it is important to check what?
routinely check the rubber tips and the integrity of the aid
84
Use physical restraints only as a (BLANK), when patients' behavior places them or others at risk for injury
last resort
85
what do nursing home staff need before they can use restraints?
the patients consent
86
Current law prohibits the unnecessary use of restraints except when?
In emergencies
87
what are chemical restraints?
Medications such as anxiolytics and sedatives used to manage a patient's behavior
(Not a standard treatment or dosage for patient's condition)
88
what is required for the use of restraints?
a physicians order based on a face-to-face assessment of the patient
89
You must conduct an ongoing (BLANK) of patients who are restrained
Assessment
90
*Restraint use must meet one of the following objectives: (4)
*Reduce the risk of patient injury from falls
*Prevent interruption of therapy such as traction, IV infusions, nasogastric (NG) tube feeding, or Foley catheterization
*Prevent patients who are confused or combative from removing life-support equipment
*Reduce the risk of injury to others by the patient
91
What are 2 alternatives to restraints?
Electronic alarm devices and posey bed
92
Many deaths from entrapment and falls have occurred due to what?
the use of all four bed rails
93
TRUE OR FALSE: side railed used to prevent a patient, such as one who is sedated, from falling out of bed are considered a restraint
F
94
Nursing measures for fires include: (3)
1) Complying with the smoking policies
2) Keeping combustable materials away from heat sources
3) Having an evacuation plan in place
95
What do you do if a fire occurs at a healthcare agency?
RACE (Rescue, Alarm, Contain, Extinguish)
96
Who is at increased risk for seizure?
Patients who have experienced some form of neurological injury or a metabolic disturbance
97
What is a seizure?
A hyperexcitation and disorderly discharge of neurons in the brain leading to a sudden, violent, involuntary series of muscle contractions that is paroxysmal and episodic, causing loss of consciousness, falling, tonicity., and clonicity.
98
Before a seizure some patients report what?
an "Aura" which is often a bright light, smell, or taste
99
A person in the community needs to be taken to a medical facility immediately if he or she has repeated seizures...
If a single seizure lasts longer than 5 minutes without any sign of slowing down or is unusual in some way; if the person has trouble breathing afterwards or appears to be injured or in pain; or if recovery is different from usual.
100
Repeated or prolonged Seizures indicates what?
Epilepticus (Medical EMERGENCY)
101
Describe seizure precautions(3)
1) Protect patient from traumatic injury
2) Position for adequate ventilation and drainage of oral secretions
3) Provide privacy and support following seizure
102
What is an emergency management plan?
A plan of action in the event of a disaster
103
what precautions are used when dealing with patients involved in a bioterror attack?
standard precautions or isolation precautions depending on the issue
104
What is infection?
The invasion of body tissues by disease-causing pathogens.
105
What is colonization?
the presence and growth of microorganisms within a host but without tissue invasion or damage
106
What is communicable disease?
A disease that is caused by a pathogen which can be spread from person to person
107
What are the four stages of infection?
IPIC
1) Incubation Period
2) Prodromal Stage
3) Illness Stage
4) Convalescence
108
Describe the Incubation period
time interval between initial infection and first appearance of signs and symptoms
109
Describe the Prodromal Stage
The time between the onset of nonspecific S/Sx and more specific S/Sx
110
Describe the Illness Stage
interval when patient manifests signs and symptoms specific to type of infection
111
Describe Convalescence
Interval when acute S/Sx disappear
112
What are the body's defenses against infection(3)?
1) normal flora
2) inflammatory response
3) immune response
113
What are normal flora?
microbes that inhabit the body but do not cause problem if they reside in their normal place of residence in the body
114
Where are floras located(4)?
SOSI
1) Skin
2) Saliva
3) Oral mucosa
4) Intestinal walls
115
Describe a superinfection
Develops when broad spectrum antibiotics kill off your normal flora and not just the organism making you sick. with no normal flora and reduced body defenses, disease producing microbes can take over
116
Describe inflammation
1) reaction that delivers fluid, blood, and nutrients to area of injury
2) Kills pathogens and necrotic tissue to enable healing
117
what are signs of localized inflammation(5)
1) Swelling
2) Redness
3) Heat
4) Pain or tenderness
5) Loss of function in affected body part
118
what are signs of systemic inflammation(7)?
1) Fever
2) WBC increased
3) Malaise
4) Anorexia
5) Nausea and/or vomiting
6) Lymph node enlargement
7) Organ failure
119
Describe the appearance and contents of Serous, Sanguineous, and Purulent exudate
Serous - clear or straw colored/plasma
Sanguineous - Red or pink/Red blood cells
Purulent - yellow, white, green/ WBC and bacteria
120
What can HAIs come from(4)?
1) Invasive procedures
2) Antibiotic administration
3) Presence of MDROs
4) Breaks in infection and control activities
121
What increases the risk of HAIs(4)?
1) Invasive procedures
2) Medical therapies
3) Long hospitalizations
4) Contact with healthcare personnel
122
what is the best way to prevent infection?
wash hands
123
What is an Iatrogenic infection?
- a type of HAI that results from a diagnostic or therapeutic procedure
e.g. Bronchoscopy or broad spectrum antibiotic treatments
124
What is an Exogenous infection?
An infection that comes from microbes found outside the individual such as Salmonella. They do not exist as normal floras
125
What is an Endogenous infection?
Occurs when part of the patient's flora becomes altered and an overgrowth results such as streptococci.
often happens when broad spectrum antibiotics alters normal floras
126
What are the factors influencing infection prevention and control(5)?
SDANC
1) Stress
2) Disease
3) Age
4) Nutrition
5) Compromised immune system
127
patients with diseases of the immune system are at particular risk for what?
infection
128
Leukemia, HIV/AIDS, and aplastic anemia are examples of what?
Autoimmune diseases (diseases that weaken the immune system)
129
why are people with chronic diseases such as diabetes mellitus and multiple sclerosis more susceptible to infection?
general debilitation and impairment
130
throughout life the susceptibility of infection changes. Elaborate:
Infants - immature defenses against infection
Young/middle-aged adult - refined defenses against infection
Older adult - immune response declines, particularly cell-mediated immunity
131
describe how nutrition affects susceptibility to infection
A reduction in the intake of protein, carbs, and fat impairs immune response and wound healing
132
Describe how stress affects the body's ability to fight infection
- elevated cortisol levels result in decreased resistance to infection.
- Prolonged stress leads to exhaustion which causes the body to be too tired to put up a fight
133
patients with burns have a high susceptibility to (BLANK)
Infection
134
Assessment related to infection involves a thorough investigation of what(4)?
1) Defense mechanisms, susceptibility, and knowledge of how infections are transmitted
2) Review of systems and travel history
3) Patient's immunizations and vaccinations
4) Medication history
135
why do nurses need to assess a patients medication history when performing an infection related assessment?
to determine whether patient is taking any medication that increases susceptibility to infection
136
where are localized infections most common?
in areas of skin or mucus membrane breakdown
e.g. surgical or traumatic wounds, pressure ulcers, oral lesions, and abscesses.
137
what can happen if a localized treatment for infection has failed?
systemic infection (Sepsis)
138
What are some Atypical signs and symptoms of infection(3)?
1) Confusion
2) Incontinence
3) Agitation
139
What are some lab results that indicate infection(2)?
1) Increased WBC
2) Positive lab culture
140
Lab values are not enough to detect an infection. What else do you need to determine infection?
Assess for other clinical signs
141
Risk for infection
Risk for cross-infection; increased risk for the transmission of an infection from one person to another with different pathogens in the same environment
Risk for surgical site infection: Increased risk for an infection at the surgical site
what are these?
Nursing Clinical Problems for infection risk
142
The patient will:
Be free from infection
Adhere to the prescribed therapeutic regimen
Identify infection risks
Implement measures to reduce exposure to potential infection
What are these?
Infection related outcomes
143
develop realistic outcomes so that...
interventions are purposeful, direct, and measurable
144
when is hand sanitizer ok to use?
when hands are not visibly dirty and when you have not come into contact with C. Diff
145
what is asepsis?
the absence of pathogenic microbes
146
what are forms of asepsis(4)?
1) Medical asepsis
2) Standard precautions
3) Hand hygiene
4) Alcohol-based hand rub
147
In acute care, treating an infection includes:
eliminating the infectious organism and supporting the patient's defenses
148
preventing an infection from developing or forming is an example of...
Health promotion
149
Why do you need to keep patients skin well lubricated with lotion?
to prevent skin breakdown and infection
150
wiping from the urinary meatus toward the rectum for women prevents...
UTI
151
When it comes to urinary catheters, when the system remains closed, it remains (BLANK)
Sterile
152
1) Separate personal care items
2) safely handle exudate
3) Wound cleaning
4) Cough etiquette
5) Handling dirty linen properly
6) Maintaining skin integrity
7) Perineal care after toileting
8) Proper use and care of urinary catheter systems and drainage sets
These are things that...
Improve patient safety by preventing infection
153
Contact precautions requires:
A gown and gloves
154
Droplet precautions requires:
-Surgical mask when within 3 feet of patient
-Proper hand hygiene
-some-dedicated care equipment (hamper, vital cart, etc.)
155
Airborne precautions requires:
Negative pressure room and N95 respirator
156
Protective environment requires:
-a private room
-positive airflow
-HEPA filtration for incoming air
-mask for the client when out of the room
157
What is OPIMs?
Other potentially infectious materials
