NSG 106- Safety, Infection, sterile technique

sterile packages should be assessed for

-color change/line -punctures/tears -discoloration -moisture

fingernails

-no artificial nails (harbor pathogens) -1/4 " or shorter - polish can chip into sterile field

TUG (timed Get up and Go)

-sand up from armless chair, walk 10 feet, turn around and sit down -give one practice trial that is not included in the score >12 seconds is a high risk for falling

pediatric considerations

-simple explanations -let child see your face before applying mask

those at risk for latex allergy

-spina bifida -frequent urinary cath -high latex exposure -family/personal history -allergy to avocado, banana, kiwi, chestnut -rubber industry workers

surgical asepsis technique is used

-sterile dressing change -compromised skin integrity -starting IV line -inserting urinary cath

procedures that require sterile technique

-urinary cath -tracheal suctioning -lumbar puncture (not feeding, sitz bath or rectal suppository)

how many patients get at least one hospital acquired infection

1 in 25

Principles of Surgical Asepsis

1. all items in sterile field sterile 2. punctures, tears, moisture-unsterile 3. 1" border- unsterile 4. table level only 5.question or doubt-unsterile 6. sterile to sterile 7. limited movement 8. out of sight- unsterile 9. prolonged air exposure- unsterile

steps in opening a sterile package

1. apply PPE 2. perform HH 3. open outermost flap 4. open side flaps 5. open flap near body 6. only 1" border ins unsterile

Three phases of a seizure

1. aura (start of seizure) 2. ictus (physical part- contractions) 3. postictal (after effects- numbness in arms, altered consciousness, partial paralysis)

use clean gloves

1. blood and body fluids, mucous membranes 2.skin not intact 3.risk of drainage

six elements in chain of infection

1. infectios agent or pathogen 2. reservoir (chicken salad) 3. port of exit 4. mode of transmission 5.portal of entry to host 6.a susceptible host

factors that produce increased susceptibility

1. lack of immunizations 2. poor nutrition 3. inadequate rest/sleep

contact precautions

1. single room 2. PPE (gown and gloves) 3. limited transport 4. disposable/dedicated pt care equip 5. dispose of PPE and HH when you leave the room

pouring sterile solutions

1. verify contents and exp date 2. place receptacle near edge 3. remove cap- upward motion 4. bottle away from field (side) 5. pour 1 to 2 " above container 6. label faces palm of hand 7. if cap is replaced you can't ensure content sterility

Five moments for HH

1. walk in room 2. exit room 3. before pt touch 4. before aseptic procedure 5. after gloves removed

if you have respiratory symptoms either

1. wear a mask 2. avoid assisting with procedures 3. stay 3 feet away from others when coughing

seizure guidelines

1. within 2 min of loss of consciousness, establish and protect the airway 2. keep airway patent and administer O2 3. meature vitals, O2 sat, BP, HR right away and every 2 min 4. est IV line 5. when seizure subsides, artificial airway is inserted if gas exchange is compromised or pt has increased intracranial pressure

when coughing sit at least

3 feet away from others

status epilepticus

5 minutes of continuous seizure no recovery between seizures medical emergency

examples of medical asepsis

HH, barrier techniques, environm cleaning

airborne PPE

N95 mask (must be fitted for) (also need private negative pressure room) close door when leaving

When is sterile technique used?

When skin incisions are made or when working in an operating room (invasive procedre, OR, L&D, cath lab)

irritant dermatitis

actue: red, dry, itchy and irritated chronic: dry, thick skin, crusting or cracking, open sores

SPLATT

assess previous falls Symptoms at the time of fall Previous Fall Location of Fal Activity at time of fall Time of Fall Trauma after fall

use soap and water when your pt has

c diff norovirus

sterile donning of PPE

cap mask eyewear gown gloves (sterile)

proper sequence for applying PPE (surgical)

cap mask eyewear gown

a solution used to reduce bacterial count on pt skin

chlorhexadine

Bottom 2 side rails

considered restraint, need HCP order

Type I immediate hypersenisitvity

could be life threatening, begin 2-3 minutes after contact up to several hours hives, swelling, low BP, bronchospasm, anaphylaxis

Double gloving is recommended because ___.

decreases risk of percutaneous injury

wash hands when they feel

dirty

which hand do you don glove first

dominant hand

sterile gloving

dominant hand first, pick up glove at cuff interlock gloves when done

when you are rinsing your hands after HH, rinse water should not run

down arms onto clean hands

masks are used for

dressing change for PICC or central line -large open wound, splash risk, immunocompromised pt

use barrier protection PPE

face mask, goggles, when risk of splash

signs of systemic infection

fever change in WBC count 24 hours after procedure

droplet precautions

for pt known or suspected of pathogens transmitted by droplets when pt is coughing, sneezing or talking (dipthereia, rubella, pertussis, mumps, mycoplasma pneumonia, sepsis, pneumonia, plague)

isolation precautions

give oral meds in wrapper or cup do not use electronic thermometer with c diff close door if pt is on airborne precautions

doffing PPE

gloves eyewear gown mask

proper sequence for removing PPE

gloves eyewear gown mask cap

donning PPE

gown mask eyewear gloves

proper sequence for applying PPE

gown mask goggles gloves

sterile technique nursing diagnoses

ineffective protection risk for infection risk for injury

when you reach over a sterile field

it becomes unsterile

isolation precautions are used when

known or suspected colonization or infection

droplet PPE

mask or respirator, private room

required in surgical areas

mask, cap, booties

PPE includes

mask, cap, eyewear, gown, gloves

airborne precautions

measles, chicken pox, TB private room, negative pressure, N95 mask droplet smaller than 5 microns

airborne precautions

measles, chicken pox, shingles, TB (my chicken has TB)

types of restraints

mitten, elbow, belt, extremity (wrist)

can NAP prepare a sterile field

no

more seizure guidelines

prevent injury and falls, do not restrain or put anything in their mouth -place near nurses station -of patient fell, do not move without a cervial collar -turn on side and use suction to remove contents from oropharynx with the Yankauer

not considered sterile and need separate work area for preparation

providone iodine and chlorhexidine

Type IV delayed hypersensitivity

reaction to chemicals used in latex processing acute: dy, red, rash, itchy, hives, blisters chronic: dry, thickened skin, vessicles, peeling (4-96 hours after exposure)

signs of localized infection

redness, heat, swelling, pain, drainage, notify HCP immed

face shield

should be removed before mask

Three types of latex allergy

type 1 (immediate) type 4 (delayed) irritant dermatitis

sterile back above_____level considered sterile

waist