PrepU Chapter 24: Aspesis and Infection Control

A veteran nurse is working with a new graduate nurse. The graduate nurse states that she was exposed to a client's blood and that she was not wearing any PPE. Which would be considered significant blood exposures by occupational health? Select all that apply. - hepatitis C - tuberculosis - HIV - Hepatitis B

- hep c - HIV - hep b

Droplet vs airborne transmission

Droplet: Cough or sneeze (greater than 5 mcm) AIrborn: Remains in air (less than 5 mcm)

stages of infection

Incubation period Prodromal stage (early signs and symptoms that are vague and nonspecific; often unaware of being contagious) Full stage of illness decline: # of pathogens decline. signs and symptoms begin to fade Convalescent period: recovery

A nurse has put on personal protective equipment (PPE) to perform the dressing change of a client's surgical wound. While the nurse is cleansing the incision, the client begins bleeding and blood hits the nurse's wrist, running down under the cuff of her glove. What is the nurse's best action? - Interrupt the dressing change to perform thorough handwashing, and document the exposure according to protocol. - Remove the contaminated gloves and apply a clean pair of gloves. - Perform thorough hand hygiene immediately after completing the dressing change. - Rinse the infected hand with hydrogen peroxide after applying a sterile bandage to the client's wound.

Interrupt the dressing change to perform thorough handwashing, and document the exposure according to protocol.

Which client would the nurse consider the most infectious?

prodromal stage

The nurse applies an alcohol-based hand rub upon entering the client's room. The client becomes upset stating, "You did not wash your hands!" Which response by the nurse is most appropriate?

"Alcohol-based hand rub provides the greatest reduction in microbial counts on the skin."

The nurse is preparing a sterile field for a procedure in the client's presence. Which is the most appropriate instruction to give the client in this situation? "It's alright if you want to look at the supplies. Just be careful not to touch them." "I've set up this sterile field for your procedure, so please do not touch anything around the tray." "Do not touch this, or I will have to start over. " "Everything is ready, I will leave the tray here for the provider."

"I've set up this sterile field for your procedure, so please do not touch anything around the tray."

Which client should the nurse determine is at greatest risk for vancomycin-resistant enterococci (VRE) infection?

- client receiving chemotherapy

means of transmittion

- direct contact (touch) - indirect contact a. vector: living creature that transmit an infectious agent b. formite: inanimate object

The nurse caring for a client after hip surgery enters the room to take the client's vital signs. Which precaution should the nurse use?

- hand hygiene -nonsterile gloves

A lead nurse is removing personal protective equipment after dressing the infected wounds of a client. Which is the priority nursing action? - handwashing before leaving the client's room - make contact between two contaminated surfaces - make contact between two clean surfaces - remove the garments that are most contaminated

- handwashing before leaving the client's room

A team of nurses is caring for a client with tuberculosis. They have not been fitted for N95 respirators. How will the team proceed with care? A. refrain from providing care until a nurse who has been fitted arrives B. utilize a powered air purifying respirator (PAPR)

B. utilize a powered air purifying respirator (PAPR)

Which client should the nurse determine to be at the greatest risk for hospital-acquired infection (HAI)? Client with a surgical wound OR Client with a urinary catheter

Client with a urinary catheter

A nurse provides care for an adolescent who is diagnosed with mononucleosis. Which crucial information does the nurse include in client education about the condition? Select all that apply. - Cover coughs or sneezes to reduce the risk of spreading infection. - Mononucleosis is called the "kissing disease" so refrain from kissing. - It is important to practice safe sex because a form of mononucleosis can be transmitted through sexual contact. - Because mononucleosis is spread through saliva, do not share food, drinks, or silverware. - The Epstein-Barr virus (EBV) causes mononucleosis.

Cover coughs or sneezes to reduce the risk of spreading infection. - Mononucleosis is called the "kissing disease" so refrain from kissing. - It is important to practice safe sex because a form of mononucleosis can be transmitted through sexual contact. - Because mononucleosis is spread through saliva, do not share food, drinks, or silverware. - The Epstein-Barr virus (EBV) causes mononucleosis.

The nurse is setting up a sterile field to perform a catheterization when the client touches the end of the sterile field. What would be the nurse's next appropriate action? - Change the sterile field, but reuse the sterile equipment. - Proceed with the procedure since it was only touched by the client. - Call for help and ask for new supplies. - Discard the sterile field and the supplies and start over.

Discard the sterile field and the supplies and start over.

A family member with a mild upper respiratory infection comes to visit a client in a long-term care facility. The nurse takes the opportunity to teach the family member about preventing the spread of the cold. What response by the family member indicates that the nurse's teaching was successful? - "I will not visit my family member in the first 3 days of my cold." - "If I sneeze or cough, I will make sure to cover my mouth with hand or tissue." - "I will obtain a mask from the staff and wash my hands before touching my family member." - "I will use tissue to cover my nose and mouth while I am visiting and will refrain from touching my family member."

I will obtain a mask from the staff and wash my hands before touching my family member."

Type of MDROs

MRSA: methicillin-resistant staphylococcus aureaus VRE: vancomycin-resistant enterococcus C.Diff: clostridium difficile colitis Other: MDR-TB, Penicillin-resistant strep pneumonia, E.coli Antibiotic Resistant Superbug

organism's potential to produce disease

Number of organisms (the more the better) Virulence (ability to produce disease0 Competence of person's immune system Length/intimacy of contact between person and organism (colonization=long contact)

A nurse is caring for a child who is hospitalized for diphtheria. Which guideline would be appropriate when caring for this client? - Ensure that hard surfaces in the room are disinfected at least once per day. - Wear personal protective equipment (PPE) when entering the room for all interactions that may involve contact with the client. - Place client in a private room that has monitored negative air pressure. - Use a private room with the door closed at all times

Wear personal protective equipment (PPE) when entering the room for all interactions that may involve contact with the client.

disease carriers - reservoir

asymptomatic but can transmit disease

The nurse is initiating isolation precautions for a client who has chronic Clostridium difficile infection. What should the nurse be sure to include with these precautions? recognize that this type of infection requires droplet precautions be sure that there are gloves of various sizes and gowns for use

be sure that there are gloves of various sizes and gowns for use C Diff is contact precaution

MRSA isolation precaution - which patient most at risk?

contact precaution

VRE isolation precaution

contact precaution

diphtheria

droplet precaution

chain of infection

infectious agent reservoir portal of exit mode of transmission portal of entry susceptible host

The nurse is preparing a client in airborne precautions for severe acute respiratory syndrome (SARS) to be transported to radiology. Which intervention will the nurse select to transport the client? Select all that apply. place a mask on the client cover the client with a sheet during transport communicate about precautions with the health care team prepare the transport stretcher with a clean sheet

place a mask on the client cover the client with a sheet during transport communicate about precautions with the health care team prepare the transport stretcher with a clean sheet

neutropenic

protective environment

virus - size - examples

smallest common cold, hepatitis B and C, AIDS

hep B precautions

standard/universal

Which factor has contributed to resistant microbial strains? - use of topical antibiotics on skin abrasions - antibiotic use for bacterial infections - use of antibiotics in clients with viral infections - mutation of common disease-causing viruses

use of antibiotics in clients with viral infections

2 phases of inflammation

vascular: small blood vessels constrict; followed by vasodilation of arterioles (this increase blood flow results in redness and heat) ; histamine released -- increased permeability (swelling) cellular stage: WBC move to area; neutrophils engulf the organism

MDRO Risk Factors

•Previous exposure to antibiotics •Impaired body defenses •Severe illness •Invasive procedures or devices •Repeated hospitalization •Advanced age