Asepsis and Infection Control

Step by step SURGICAL ASEPSIS: SURGICAL GLOVING - OPEN TECHNIQUE

-Open the outer packaging and remove the inner glove packaging. -Place the inner packaging on a fat surface at waist height. -Fold back the edges of the inner wrapper to expose the gloves. Do not touch the inside of the wrapper. -Using the thumb and forefinger of the nondominant hand, pinch the cuff of the dominant hand glove. Only touch the inside surface of the glove. -Lift the glove off of the wrapper and carefully apply to the dominant hand without touching the outside surface of the glove. If glove is not aligned with fingers correctly, do not adjust the glove. -Using the gloved (dominant) hand, slide fingers under the cuff of the remaining glove. -Lift the glove off of the wrapper by touching only the outside surface of the glove. -Apply the glove to the nondominant hand. -Once the second glove is applied, adjust the gloves as necessary.

A nurse has just finished a wound irrigation for a client who requires contact precautions. Which of the following pieces of PPE should the nurse remove first? A. Gloves B. Gown C. Face shield D. Mask

A gloves the most soiled should be removed first failing to remove the most contaminated item first increases the risk.

A nurse is assisting w/ teaching a newly licensed nurse about airborne infection isolation rooms (AIIR). Which of the following information should the nurse include? A. The door to the AIIR should remain closed B. Clients who are on contact precautions require AIIR C. An AIIR has at least 4 air exchanges each hour D. A mask is not needed to care for clients who are in an AIIR

A. The door should remain closed at all times to reduce the risk of transmission of an infectious agent Has at least 6-12 exchanges of air each hour

A nurse is observing a newly licensed nurse prepare a sterile field. For which of the following actions should the nurse intervene? A. Positioning the wrapped package on the bedside table so the outer flap is away from her. B. Holds a bottle of solution w/ the label away from the palm of the hand C. Holds gauze packages 15cm(6in) above the sterile field D. Wears sterile gloves when moving sterile items on the sterile field

B. The nurse should hold the bottle of sterile solution with the label against the palm of the hand so that if any of the solution drips onto the outside of the bottle it does not damage the label and make it illegible.

A nurse is admitting a client who has pertussis. Which of the following types of transmission-based precautions should the nurse initiate? A. Airborne B. Contact C. Droplet D. Protective

C. Droplet

chain of infection

Causative agent Reservoir Portal of exit Mode of transmission Portal of Exit

susceptible host

Compromised defense mechanisms (immunocompromised, breaks in skin), leaving the host more susceptible to infections

Non-Risk Waste consist of:

Paper and cardboard Packaging Food Waste Aerosols(spray)

Convalescence stage

Recovery from the infection; interval when acute findings disappear, total recovery taking days to months

Causative agent

bacteria, virus, fungus, prion, parasite

Findings during the third stage of the inflammatory response (local infection) include the following.

damaged tissue is replaced by scar tissue. Gradually, the new cells take on characteristics that are similar in structure and function to the old cells.

reservoir

human, animal, food, organic matter on inanimate surfaces, water, soil, insects)

Illness stage

presence of specific signs and symptoms of the disease; interval when findings specific to the infection occur

portal of entry

to the host: Might be the same as the portal of exit

Maintaining medical asepsis

•Hand hygiene-soap/water or alcohol based products •Cough etiquette •Respiratory hygiene •Hair- washed frequently and short or pulled back •Nails- short. Free of nail polish, gels, acrylic •Remove jewelry •Protective clothing •Masks, gown, gloves, protective eye wear •Physical environment practices

Acquired Immunity

Immunity you develop during your life; active and passive

How to prevent infection

Maintain standard precautions and HAND HYGIENE

portal of exit

(means for leaving) the host ● Respiratory tract (droplet, airborne): Mycobacterium tuberculosis and Streptococcus pneumoniae ● Gastrointestinal tract: Shigella, Salmonella enteritidis, Salmonella typhi, hepatitis A ● Genitourinary tract: Escherichia coli, hepatitis A, HSV, HIV ● Skin/mucous membranes: HSV and varicella ● Blood/body fluid

Findings identifiable in the nursing assessment of systemic infection include the following.

*****Fever***** ◯ Presence of chills, which occur when temperature is rising, and diaphoresis, which occurs when temperature is decreasing ◯ Increased pulse (tachycardia) and respiratory rate (in response to the high fever) ◯ Malaise ◯ Fatigue ◯ Anorexia, nausea, and vomiting ◯ Abdominal cramping and diarrhea ◯ Enlarged lymph nodes (repositories for "waste") *****WBCs greater than 10,000*, left shift (increase in neutrophils), ESR over 20mm******

A nurse has a completed care procedure for a client who requires airborne precautions. Which of the following items of PPE should the nurse remove first? A. Mask B. Gloves C. Gown D. Goggles

A. Gloves The nurse should remove the gloves first, as they are the most contaminated.

A nurse should assess each client for the risks of infection specific to the client, the disease or injury, and the environment. The most common risks include:

● Inadequate hand hygiene (client and caregivers) ● Individuals who have compromised health or defenses against infection, which include: ◯ Those who are immunocompromised ◯ Those who have had surgery ◯ Those with indwelling devices ◯ A break in the skin (the body's best protection against infection). ◯ Those with poor oxygenation ◯ Those with impaired circulation ◯ Those who have chronic or acute disease (diabetes mellitus, adrenal insufficiency, renal failure, hepatic failure, or chronic lung disease) ● Caregivers using medical or surgical asepsis that does not follow the established standards (11.2) ● Clients who have poor personal hygiene or poor nutrition, smoke, or consume excessive amounts of alcohol, and those experiencing stress ● Clients who live in a very crowded environment -OLDER ADULT CLIENTS: Older adults can have a slowed response to antibiotic therapy, slowed immune response, loss of subcutaneous tissue and thinning of the skin, decreased vascularity and slowed wound healing, decreased cough and gag reflexes, chronic illnesses, decreased gastric acid production, decreased mobility, bowel and bladder incontinence, dementia, and greater incidence of invasive devices (a urinary catheter or feeding tube). ● Individuals who make poor lifestyle choices that put them at risk, which include: ◯ Clients who use IV drugs and share needles ◯ Clients who engage in unprotected sex ● Clients who have recently been exposed to: ◯ Poor sanitation ◯ Mosquito‑borne or parasitic diseases ◯ Diseases endemic to the area visited, but not in the client's home country

Laboratory Test to detect infection

● Leukocytosis (WBCs greater than 10,000/μL) ● Increases in the specific types of WBCs on differential (left shift = an increase in neutrophils) ● Elevated erythrocyte sedimentation rate (ESR) over 20 mm/hr; an increase indicates an active inflammatory process or infection ● Presence of micro‑organisms on culture of the specific fluid/area

Pouring Sterile Solutions

● Remove the bottle cap. ● Place the bottle cap face up on a clean (nonsterile) surface. ● Hold the bottle with the label in the palm of the hand so that the solution does not run down the label. ● First pour a small amount (1 to 2 mL) of the solution into an available receptacle. ● Pour the solution (without splashing) onto the dressing or site without touching the bottle to the site. ● Sterile solutions expire 24 hr after opening and recapping in some facilities. Other facilities' policies state that once a sterile solution container is opened, it can be used only once and then thrown away.

Nursing Care when infections are present

****Use frequent and effective hand hygiene before and after care.**** ● Educate the client about the required and recommended immunizations and where to obtain them. The target groups include children, older adults, those with chronic disease, and those who are immunocompromised and their families and contacts. ● Educate the client and ask for a return demonstration of good oral hygiene. Good oral hygiene decreases the protein (which attracts micro‑organisms) in the oral cavity, which thereby decreases the growth of micro‑organisms that can migrate through breaks in the oral mucosa. ● Encourage the client to consume an adequate amount of fluids. Adequate fluid intake prevents the stasis of urine by flushing the urinary tract and decreasing the growth of micro‑organisms. Adequate hydration also keeps the skin from breaking down. Intact skin prevents micro‑organisms from entering the body. For immobile clients, ensure that pulmonary hygiene (turning, coughing, deep breathing, incentive spirometry) is done every 2 hr, or as prescribed. Good pulmonary hygiene decreases the growth of micro‑organisms and the development of pneumonia by preventing stasis of pulmonary excretions, stimulating ciliary movement and clearance, and expanding the lungs. ● Use of aseptic technique and proper personal protective equipment (gloves, masks, gowns, and goggles) in the provision of care to all clients prevents unnecessary exposure to micro‑organisms. ● Teach and use respiratory hygiene/cough etiquette. It applies to anyone entering a health care setting (clients, visitors, staff) with manifestations of illness, whether diagnosed or undiagnosed. This includes cough, congestion, rhinorrhea, or an increase in the production of respiratory secretions. The components of respiratory hygiene and cough etiquette include: ◯ Covering the mouth and nose when coughing and sneezing. ◯ Using facial tissues to contain respiratory secretions and disposing of them promptly into a hands‑free receptacle. ◯ Wearing a surgical mask when coughing to minimize contamination of the surrounding environment. ◯ Turning the head when coughing and staying a minimum of 3 ft away from others, especially in common waiting areas. ◯ Performing hand hygiene after contact with respiratory secretions and contaminated objects/materials.

Step by step preparing a sterile field

-Gather necessary supplies. -Perform hand hygiene. -Open the sterile drape by removing the outer wrapping. -Place sterile kit or tray in the center of the work surface. -Open the fap farthest from the body by reaching around the sterile area. -Open the side faps, then the fap closest to the body. -Using fingertips, pick up the sterile drape, touching only the 1-inch margin. -Lay the drape on the work surface with the fluid-resistant side facing down. POURING A STERILE SOLUTION -Examine the container/solution for expiration date and verification of contents. -Remove the cap without contaminating the lip of the container or the inside of the cap. -Pour the solution into the sterile basin from a height of 4 to 6 inches. Do not touch or spill fluid on the sterile field -Recap container away from the sterile field without contaminating the lip of the container or the inside of the cap.

Step by step Surgical Asepsis: Surgical Gowning - Independent

-Lift the pre-opened gown from the sterile field by touching only the inside surface of the gown. -Step back from the sterile field and unfold the gown by holding the gown just below the neck band. -Insert arms into the sleeves, ensuring that arms and hands stay above the waist. -Once the cuff of the sleeve has been reached, do not insert arms any further. -A nonsterile assistant will pull the gown up onto the shoulders while only touching the inside surface of the gown. -The assistant will secure the gown at the neck and back

Step by step Surgical Asepsis: Surgical Alcohol-based Hand Scrub Method

-Prior to starting surgical scrubbing, apply the cap, shoe covers, mask, and protective eyewear. -Remove all jewelry and dispense the recommended amount of hand rub to the palm of one hand. -Perform standard hand hygiene. -Apply alcohol-based scrub per manufacturer's instructions. -Rub product on hands and forearms. -Repeat if necessary. -Allow hands and arms to air dry prior to applying a gown or gloves

Step by step Surgical Asepsis: Surgical Traditional Hand Scrub Method

-Prior to starting surgical scrubbing, apply the cap, shoe covers, mask, and protective eyewear. -Remove all jewelry and wash the hands and arms using an antimicrobial soap with warm water. -Clean under the nails with a nail tool. Scrub the fingers, between the fingers, the palm of the hands, and the back of the hands for at least 2 minutes. -Scrub the arms. Keep the hands higher than the arms at all times. -Scrub the sides of the arms and up to 2 inches above the elbow. - Rinse the hands and arms in one direction only, using warm water. Keep hands above arms. Proceed to the surgical area keeping hands above higher than the arms

Step by step Surgical Asepsis: Surgical Gowning - Dependent

-The sterile person lifts the gown off of the sterile field, only touching the outside surface of the gown. -The sterile person opens the gown for the team member to insert the arms into the sleeves. -Once the team member has inserted the arms into the sleeves, a nonsterile person will secure the gown at the neck and back. -Give the paper tab at end of the sterile tie to a nonsterile team member. Turn your body completely around while the nonsterile team member stands still. -Take back sterile tie (without paper tab) from nonsterile team member and secure tie to gown

Step by step SURGICAL ASEPSIS: SURGICAL GLOVING CLOSED TECHNIQUE

-Using the sleeve of the sterile gown, grasp the cuff of the nondominant hand glove. Hands should not be visible at the end of the gown sleeve. -Place the glove in the palm of the nondominant hand with the opening of the glove facing away from the body. -Pinch the glove at the cuff with the nondominant hand and pull the glove over the end of the sleeve of the nondominant hand. -Repeat the same steps on the dominant hand. -Once both gloves have been applied, adjust as necessary. Ensure that the cuff of the sleeve is completely covered by the glove.

A nurse is caring for a client who requires isolation for active pulmonary tuberculosis. Which of the following precautions should the nurse include when creating a sign to post outside of the client's room? (select all that apply) A. Mask B. Keep door closed C. Gown D. Dispose sharps in sharps container E. Perform proper hand hygiene

A, B, D and E A protective mask is correct. Clients who have active pulmonary tuberculosis require airborne precautions. Everyone entering the room requires respiratory protection, in the form of an appropriate filtration mask. A closed door is correct. Clients who have active pulmonary tuberculosis require airborne precautions. Everyone entering or leaving the room should close the door behind them. A gown is incorrect. Gowns are unnecessary for every individual entering the room; however, any staff who anticipate contact with body fluids should wear them. A puncture-proof sharps container is correct. Nurses must always dispose of needles and sharp instruments in puncture-proof sharps containers. Hand hygiene is correct. Hand hygiene is essential before and after all contact with clients

A nurse is wearing sterile gloves in preparation for performing a sterile procedure. Which of the following object can the nurse touch without breaching sterile technique? (select all the apply) A. A bottom containing a sterile solution B. The edge of the sterile drape at the base of the field C. The inner wrapping of an item on the sterile field D. An irrigation syringe on the sterile field E. One gloved hand with other gloved hand

A. A bottle of sterile solution is sterile on the inside and non-sterile on the outside. Prepare the sterile container of solution on the field before putting on sterile gloves. B. The 1‑inch border at the outer edge of the sterile field is not sterile. Do not touch it with sterile gloves. C. CORRECT: The inner wrappings of any objects dropped onto the sterile field are sterile. Touch them with sterile gloves. D. CORRECT: Any objects dropped onto the sterile field during the setup are sterile. Touch the syringe with sterile gloves. E. CORRECT: One sterile gloved hand may touch the other sterile gloved hand because both are sterile.

A nurse is wearing sterile gloves in preparation for performing a sterile procedure. Which of the following objects can the nurse touch without breaching sterile technique? (Select all that apply.) A. A bottle containing a sterile solution B. The edge of the sterile drape at the base of the field C. The inner wrapping of an item on the sterile field D. An irrigation syringe on the sterile field E. One gloved hand with the other gloved hand

A. A bottle of sterile solution is sterile on the inside and non-sterile on the outside. Prepare the sterile container of solution on the field before putting on sterile gloves. B. The 1‑inch border at the outer edge of the sterile field is not sterile. Do not touch it with sterile gloves. C. CORRECT: The inner wrappings of any objects dropped onto the sterile field are sterile. Touch them with sterile gloves. D. CORRECT: Any objects dropped onto the sterile field during the setup are sterile. Touch the syringe with sterile gloves. E. CORRECT: One sterile gloved hand may touch the other sterile gloved hand because both are sterile.

A charge nurse is planning a room assignment for a client who has a productive cough, a questionable chest x-ray, and a positive Mantoux test. Room 208 is private, negative-pressure airflow room; Room 212 is a semi-private, positive-pressure airflow room; Room 214 is a negative-pressure, semi-private room; and Room 216 is a private. positive-pressure airflow room. To which of the following rooms should the nurse assign the client? A. 208 B. 212 C. 214 D. 216

A. A client who has or might have tuberculosis requires airborne precautions. That means a private room with negative-pressure airflow. Room 208 is the only one of these options that fits these requirements.

To decontaminate their hands w/ alcohol-based gel. the nurse shoudl rub their hands together until all of the gel has exaporate and their hands are dry. Which of the folllowing is the correct rationale for why hand should be rubbed togethr until dry? A. Drying provides the full antiseptic effect. B. Residual alcohol can easily stain clothing. C. Excess gel could transfer to the client. D. Slippery gel can make the nurse drop supplies.

A. A dry environment offers better protection against the proliferation of pathogens than a moist environment does. The bactericidal alcohol components of these gels further enhance their superior antiseptic effect.

A nurse is caring for a client who has had a cough for 3 weeks and is beginning to cough up blood. The client has manifestations of which of the following conditions? A. Allergic reaction B. Ringworm C. Systemic lupus erythematosus D. Tuberculosis

A. A pink body rash is a manifestation of an allergic reaction. B. Red circles with white centers is a manifestation of ringworm. C. A red edematous rash bilaterally on the cheeks is a manifestation of systemic lupus erythematosus. D. CORRECT: A cough for 3 weeks and beginning to cough up blood are manifestations of tuberculosis.

A nurse is assisting in providing an in-service about infectious agents to a group of nurses. The nurse should include in the teaching that tuberculosis is transmitted by which of the following modes of transmission? A. Airborne B. Droplet C. Direct contact D. indirect contact

A. Airborne The nurse should include in the teaching that TB is transmitted through the airborne mode of transmission. Clients who have TB should be placed in a negative pressure, private room. The door to the client's room should remain closed, and the nurse should wear an N95 mask when providing care to the client.

A nurse is caring for a client who has a health care-associated infection (HAI). Which of the following describes an exogenous HAI? A. A Salmonella infection that occurs after eating contaminated food from the cafeteria B. An infection that occurs during a therapeutic procedure C. A yeast infection that occurs while receiving broad spectrum antibiotics D. A urinary tract infection that occurs after a sterile catheter insertion

A. An exogenous HAI is an infection acquired from pathogens found outside of the client's body, such as in contaminated food.

A nurse is assisting w/ teaching a newly licensed nurse about hand hygiene for surgical asepsis. Which of the following instructions should the nurse include? A. Use a brush to scrub the surface of the hands B. Rinse antiseptic solution from the hands before it dries C. Apply Chlorhexidine and ethanol to the hands. D. Leave jewelry on the hands when cleansing them

A. Apply Chlorhexidine and ethanol solution to their hands to remove pathogens when using surgical asepsis.

A nurse has prepared a sterile field for assisting a provider with a chest tube insertion. Which of the following events should the nurse recognize as contaminating the sterile field? (Select all that apply.) A. The provider drops a sterile instrument onto the near side of the sterile field. B. The nurse moistens a cotton ball with sterile normal saline and places it on the sterile field. C. The procedure is delayed 1 hr because the provider receives an emergency call. D. The nurse turns to speak to someone who enters through the door behind the nurse. E. The client's hand brushes against the outer edge of the sterile field.

A. As long as the provider has not reached over the sterile field (by placing the instrument on a near portion of the field), the field remains sterile. B. CORRECT: Fluid permeation of the sterile drape or barrier contaminates the field. C. CORRECT: Prolonged exposure to air contaminates a sterile field. D. CORRECT: Turning away from a sterile field contaminates the field because the nurse cannot see if a piece of clothing or hair made contact with the field. E. The 1‑inch border at the outer edge of the sterile field is not sterile. Unless the client reached farther into the field, the field remains sterile.

A nurse has complete care procedures for a client who requires airborne precautions. Which of the following items of PPE should the nurse remove last? A. Mask B. Gloves C. Gown D. Goggles

A. Mask With a client who requires airborne precautions, the nurse will continue to need the protection of the mask while removing other contaminated PPE.

A charge nurse is reviewing with a newly hired nurse the difference in manifestations of a localized versus a systemic infection. Which of the following are manifestations of a systemic infection? (Select all that apply.) A. Fever B. Malaise C. Edema D. Pain or tenderness E. Increase in pulse and respiratory rate

A. CORRECT: A fever indicates that the infection is affecting the whole body, and therefore systemic. B. CORRECT: Malaise indicates that the infection is affecting the whole body. C. Edema is a localized manifestation indicating a localized infection. D. Pain and tenderness is a localized manifestation indicating a localized infection. E. CORRECT: An increase in pulse and respiratory rate indicates that the infection is affecting the whole body.

A nurse is caring for a client who has severe acute respiratory syndrome (SARS). The nurse knows that health care professionals are required to report communicable and infectious diseases. Which of the following illustrate the rationale for reporting? (Select all that apply.) A. Planning and evaluating control and prevention strategies B. Determining public health priorities C. Ensuring proper medical treatment D. Identifying endemic disease E. Monitoring for common‑source outbreaks

A. CORRECT: Reporting of communicable and infectious diseases assists with planning and evaluating control and prevention strategies. B. CORRECT: Reporting of communicable and infectious diseases assists with determining public health policies. C. CORRECT: Reporting of communicable and infectious diseases assists with ensuring proper medical treatment is available. D. Endemic disease is already prevalent within a population, so reporting is not necessary. E. CORRECT: Reporting of communicable and infectious diseases assists with monitoring for common‑source outbreaks.

A nurse is assisting with teaching a newly licensed nurse about lab tests that can indicate generalized inflammation. The nurse should include which of the following lab tests? A. C-Reactive Protein B. Troponin C. Creatine kinase D. Lactic acid

A. CRP is a nonspecific marker that can increase when inflammation is present

A nurse is caring for a client who has influenza. The client asks how they acquired the infectious agent. The nurse should inform the client that influenza is transmitted by which of the following modes? A. Droplet B. Indirect Contact C. Airborne D. Direct Contact

A. Droplet large droplets in the air. The clients should be placed in a private room, and the nurse should wear a surgicial mask when caring the client.

Which of the following is an advantage of using alcohol-based gel? A. It takes less time to use than washing with soap and water. B. It removes gross contamination better than soap and water does. C. Its protective nature reduces the need for frequent handwashing. D. It provides adequate protection before surgical applications.

A. During an 8-hr shift, an estimated 1 hr of an intensive care unit nurse's time is saved by preforming hand hygiene with an alcohol-based gel.

A nurse is caring for a group of clients on a med surge unit. Which of the following situations requires that the nurse wear gloves? (select all that apply) A. Emptying urine from an indwelling urine collection bag B. Providing oral care C. Changing an ostomy pouch D. Delivering a food tray to a client who has AIDS E. Placing oral medication tablets into a client's hand

A. Emptying urine from an indwelling urine collection bag is correct. Standard precautions indicate that the nurse should wear gloves when in direct contact with bodily fluids. B. Providing oral care is correct. Standard precautions indicate that the nurse should wear gloves when in direct contact with bodily fluids or mucous membranes. C. Changing an ostomy pouch is correct. Standard precautions indicate that the nurse should wear gloves when in direct contact with bodily fluids or excretions.

A nurse is setting up a sterile field to perform a dressing change on a client. Which of the following actions should the nurse take? A. Open the first flap on the sterile package away from their body. B. Place objects on the sterile field at least 1.3 cm(0.5in) from the edge. C. Unwrap both sides of the sterile package at the same time. D. Set up the sterile field next to a wall in the client's room.

A. Open the first flap on the sterile package away from their body to reduce the risk of contamination.

After completing a procedure that required donning PPE consisting of a gown, an N95 respirator, a face shield and gloves, which of the following should the nurse remove first when removing PPE separately? A. The gloves B. The gown C. The face shield D. The N95 respirator

A. Gloves are considered the most contaminated and should be removed first, followed by face/eye protection, gown, and mask/respirator.

When entering a client's room to change a surgical dressing, a nurse notes that the client is coughing and sneezing. Which of the following actions should the nurse take when preparing the sterile field? A. Keep the sterile field at least 6 ft away from the client's bedside. B. Instruct the client to refrain from coughing and sneezing during the dressing change. C. Place a mask on the client to limit the spread of micro‑organisms into the surgical wound. D. Keep a box of facial tissues nearby for the client to use during the dressing change.

A. It would be difficult for to maintain a sterile field away from the bedside. But more important, this might not have any effect on the transmission of some micro‑organisms. B. The client might be unable to refrain from coughing and sneezing during the dressing change. C. CORRECT: Placing a mask on the client prevents contamination of the surgical wound during the dressing change. D. Keeping tissues close by for the client to use

When entering a client's room to change a surgical dressing, a nurse notes that the client is coughing and sneezing. Which of the following actions should the nurse take when preparing the sterile field? A. Keep the sterile field at least 6 ft away from the client's bedside. B. Instruct the client to refrain from coughing and sneezing during the dressing change. C. Place a mask on the client to limit the spread of micro-organisms into the surgical wound D. Keep a box of facial tissues nearby for the client to use during the dressing change.

A. It would be difficult for to maintain a sterile field away from the bedside. But more important, this might not have any effect on the transmission of some micro‑organisms. B. The client might be unable to refrain from coughing and sneezing during the dressing change. C. CORRECT: Placing a mask on the client prevents contamination of the surgical wound during the dressing change. D. Keeping tissues close by for the client to use still allows contamination of the surgical wound.

A nurse is contributing to the plan of care for a client who is being admitted to the facility with a suspected diagnosis of pertussis. Which of the following interventions should the nurse include? (Select all that apply.) A. Place the client in a room that has negative air pressure of at least six exchanges per hour. B. Wear a mask when providing care within 3 ft of the client. C. Place a surgical mask on the client if transportation to another department is unavoidable. D. Use sterile gloves when handling soiled linens. E. Wear a gown when performing care that might result in contamination from secretions.

A. Place a client in a private room and initiate droplet precautions if they have pertussis. Negative‑pressure airflow is required for a client who is on airborne precautions. B. CORRECT: Wear a mask when within 3 ft of the client. C. CORRECT: Place a surgical mask on the client during transport to another area of the facility. D. Wear a gown and non‑sterile gloves when performing care that might result in contamination from body fluids. E. CORRECT: Wear a gown if the nurse's clothing or skin might be contaminated with body secretions or excretions.

A nurse sees an assistive personnel (AP) entering the room of client who requires transmission-based precautions without the appropriate PPE. Which of the following actions should the nurse take first? A. Provide the appropriate PPE to the AP. B. Notify the charge nurse about the AP's need for training. C. Volunteer to provide an inservice about infection control. D. Speak with the AP when he exits the room about the appropriate protocol.

A. Provide the appropriate PPE to the AP. Due to the potential for the spread of infectious organisms to other clients the AP cares for, the nurse should intervene by providing the appropriate PPE right away.

A nurse is caring for a client who acquired an infection after touching a faucet that an infected person had touched. Which of the following links in the chain of infection does the faucet represent? A. Reservoir B. Susceptible host C. Portal of Entry D. Portal of Exit

A. Reservoir- a location where the infectious agent lives, grows, reproduces itself and waits to be transmitted to a susceptible host.

A nurse is performing a throat culture on a client. Which of the following actions shoudl the nurse take? A. Swab the back of the clients pharyngeal wall. B. Place the swab in a clean container after obtaining the culture. C. Insert the swab in the culture medium w/in 1 hour of obtaining the sample. D. Don sterile gloves to obtain the culture form the client.

A. Swab the clients tonsils, tonsillar pillars, or the back of the pharyngeal wall, to obtain an accurate culture. The nurse should avoid touching any other areas of the clients mouth or pharynx because this can interfere w/ test results

A nurse is reviewing hand hygiene techniques with a group of assistive personnel (AP). Which of the following instructions should the nurse include when discussing handwashing? (Select all that apply.) A. Apply 3 to 5 mL of liquid soap to dry hands. B. Wash the hands with soap and water for at least 15 seconds. C. Rinse the hands with hot water. D. Use a clean paper towel to turn off hand faucets. E. Allow the hands to air dry after washing.

A. The APs should apply alcohol rubs to dry hands and wet the hands first before applying soap for handwashing. B. CORRECT: This is the amount of time it takes to remove transient flora from the hands. For soiled hands, the recommendation is 2 minutes. C. The APs should use warm water to minimize the removal of protective skin oils. D. CORRECT: If the sink does not have foot or knee pedals, the APs should turn off the water with a clean paper towel and not with their hands. E. The APs should dry their hands with a clean paper towel. This helps prevent chapped skin.

A nurse has removed a sterile pack from its outside cover and placed it on a clean work surface in preparation for an invasive procedure. Which of the following flaps should the nurse unfold first? A. The flap closest to the body B. The right side flap C. The left side flap D. The flap farthest from the body

A. The flap closest to the body is the innermost flap and the last one to unfold. B. Unfold the side flap that is closest to the top of the package before the one underneath it; however, there is another flap to unfold first. C. Unfold the side flap that is closest to the top of the package before the one underneath it; however, there is another flap to unfold first. D. CORRECT: The priority goal in setting up a sterile field is to maintain sterility and thus reduce the risk to the client's safety. Unless the nurse pulls the top flap (the one farthest from her body) away from the body first, there is a risk of touching part of the inner surface of the wrap and thus contaminating it.

A nurse has removed a sterile pack from its outside cover and placed it on a clean work surface in preparation for an invasive procedure. Which of the following flaps should the nurse unfold first? A. The flap closest to the body B. The right side flap C. The left side flap D. The flap farthest from the body

A. The flap closest to the body is the innermost flap and the last one to unfold. B. Unfold the side flap that is closest to the top of the package before the one underneath it; however, there is another flap to unfold first. C. Unfold the side flap that is closest to the top of the package before the one underneath it; however, there is another flap to unfold first. D. CORRECT: The priority goal in setting up a sterile field is to maintain sterility and thus reduce the risk to the client's safety. Unless the nurse pulls the top flap (the one farthest from her body) away from the body first, there is a risk of touching part of the inner surface of the wrap and thus contaminating it.

A nurse is caring for a client who reports a severe sore throat, pain when swallowing, and swollen lymph nodes. The client is experiencing which of the following stages of infection? A. Prodromal B. Incubation C. Convalescence D. Illness

A. The prodromal stage consists of nonspecific manifestations of the infection. B. The incubation period consists of the time when the pathogen first enters the body prior to the appearance of any manifestations of infection. C. During convalescence, manifestations of the infection fade. D. CORRECT: The illness stage is when the client experiences manifestations specific to the infection.

A nurse is assisting w/ implementing an infection control bundle for clients at risk for catheter-associated urinary tract infections(CAUTIs). Which of the following interventions should the nurse include in the bundle? A. Try to use alternatives before inserting indwelling urinary catheters B. Use clean technique for insertion of indwelling urinary catheters C. Check clients every 2 days to evaluate the need for indwelling catheters. D. Disconnect the system to obtain urine sample from indwelling urinary catheters.

A. Try to use other methods of urine collection before inserting an indwelling urinary catheter, such as condom catheter, to reduce the risk for CAUTI

A nurse is providing teching to a group of assitive personnel(AP) about hand hygiene. Which of the following statements by one of the APs indicates a need for further teaching? A. "As long as I change gloves between clients, it is not necessary to wash my hands." B."I should wash my hands before I provide client care." C. "I will not wear artificial nails when providing client care." D. "It is acceptable to use alcohol-based hand products after most client contact."

A. While the use of gloves does reduce contamination, it is still necessary to perform hand hygiene between clients. This statement by one of the APs indicates a need for further teaching.

nonspecific (innate) defenses passive

Antibodies are produced by an external source. ● Temporary immunity that does not have memory of past exposures ● Intact skin, the body's first line of defense ● Mucous membranes, secretions, enzymes, phagocytic cells, and protective proteins ● Inflammatory response with phagocytic cells, the complement system, and interferons

What is Antimicrobial therapy and the nursing actions.

Antimicrobial therapy kills or inhibits the growth of micro‑organisms (bacteria, fungi, viruses, protozoans). Antimicrobial medications either kill pathogens or prevent their growth. Give anthelmintics for worm infestations. NURSING ACTIONS ● Administer antimicrobial therapy as prescribed. ● Monitor for medication effectiveness (reduced fever, increase in the level of comfort, decreasing WBC count). ● Maintain a medication schedule to ensure consistent therapeutic blood levels of the antibiotic.

Multidrug-resistant infection

Antimicrobials are becoming less effective for some strains of pathogens due to the pathogen's ability to adapt and become resistant to previously sensitive antibiotics. This significantly limits the number of antibiotics that are effective against the pathogen. Use of antibiotics, especially broad‑spectrum antibiotics, has significantly decreased to prevent new strains from evolving. Taking the measures below can ensure that an antimicrobial is necessary and therapy is effective. Methicillin‑resistant Staphylococcus aureus (MRSA) is a strain of Staphylococcus aureus that is resistant to many antibiotics. Vancomycin and linezolid are used to treat MRSA. Vancomycin‑resistant Staphylococcus aureus (VRSA) is a strain of Staphylococcus aureus that is resistant to vancomycin, but so far is sensitive to other antibiotics specific to a client's strain. NURSING ACTIONS ● Obtain specimens for culture and sensitivity prior to initiation of antimicrobial therapy. ● Monitor antimicrobial levels and ensure that therapeutic levels are maintained. CLIENT EDUCATION ● Complete the full course of antimicrobial therapy. ● Avoid overuse of antimicrobials.

What are Antipyretics (Medications) and the nursing actions?

Antipyretics (acetaminophen and aspirin) are used for fever and discomfort as prescribed. NURSING ACTIONS ● Monitor fever to determine effectiveness of medication. ● Document the client's temperature fluctuations on the medical record for trending.

A nurse is adhering to standard precautions while caring for a group of clients. For which of the following tasks should the nurse wear protective eye equipment?(select all that apply) A. Providing hygiene care to a client who is HIV-positive B. Emptying a urinary drainage bag for a client who has pneumonia C. Irrigating a client's Abd wound D. Transporting a cerebrospinal fluid specimen to the lab E. Suctioning a clients new tracheostomy tube

B and E both hold a chance of splashing in the eye

A nurse is teaching a new group of assistive personnel(AP) about the importance of hand hygiene. Which of the following statements should the nurse include? A. "If you wear gloves, you do not have to wash your hands." B. "Rub all surfaces of your hands with an alcohol rub for 20 to 30 seconds." C. "Use an alcohol rub when your hands are visibly soiled." D. "If you don't have an infection, your hands won't infect others."

B. "Rub all surfaces of your hands with an alcohol rub for 20 to 30 seconds" The staff should rub the product over all aspects of the hands and fingers until they are dry, which generally takes 20 to 30 seconds.

A nurse is planning care for a client who has manifestations of A Clostridium difficile (C.diff) infection. Which of the following actions should the nurse plan to take? A.Place a surgical mask on the client during transport. B. Place the client on contact precautions. C. Use an alcohol-based agent to perform hand hygiene when caring for the client. D. Obtain a blood specimen to test for C. difficile.

B. Clients who have manifestations of C. difficile should be placed on contact isolation until proven otherwise to prevent cross-transmission to uninfected and potentially susceptible clients

A nurse is admitting a client who has a wound infected with vancomycin-resistant enterococci (VRE). Which of the following types of precaution should the nurse plan to initiate? A. Droplet B. Contact C. Airborne D. Protective

B. Contact Contact precautions are a type of transmission-based precaution for clients who have an infection, such as VRE, which spreads either by direct or indirect contact.

A nurse is planning to admit a client who has a respiratory syncytial virus (RSV). Which of the following transmission-based precautions should the nurse plan to implement? A. Protective B. Contact C. Standard D. Airborne

B. Contact precautions are transmission-based precautions that are used when caring for a client who has RSV.

A nurse is admitting a client who has vancomycin-resistan enterococcus(VRE) of the urine. The nurse should place the client on which of the following precautions? A. Protective B. Contact C. Droplet D. Airborne

B. Contact- Reduce the risk of transmitting infectious agents, such as VRE through direct or indirect contact. The nurse should wear a gown and gloves when caring for the patient

A nurse is caring for client who states, " I am feeling so much better. My fever is gone, and I have a good appetite." The nurse should identify the client is likely in which of the following stages of infection? A. Incubation B. Convalescence C. Acute Infection D. Prodromal

B. Convalescence is the last stage in which the client returns to a previous or new, stabilized state of health.

A nurse caring for a client who has an infected wound removes a dressing saturated w/ blood and purulent drainage. How should the nurse dispose of the dressing material? A. Discard the dressing in the bedside trash receptacle. B. Dispose of the dressing in a biohazardous waste container. C. Enclose the dressing in a single clear plastic bag and discard in the bedside trash receptacle. D. Double-bag the dressing in clear bags and label it "biohazard".

B. Dispose of the dressing in a biohazardous waste container. The nurse should discard potentially infective material, such as a dressing that contains blood and pus, in a biohazardous materials container separate from the regular trash.

A nurse is assisting w/ teaching a newly licensed nurse about infectious agents. The nurse should include in the teaching that pertussis is transmitted by which of the following modes of transmission? A. Direct contact B. Droplet C. Airborne D. Indirect contact

B. Droplet pertussis is transmitted through large droplets in the air from coughing or sneezing. The client should be placed in a private room. The nurse should wear a surgical mask when providing care for clients who on droplet precautions

A nurse is assisting w/ teaching a newly licensed nurse about removing PPE. Which of the following items should the nurse instruct to remove first? A. Mask B. Gloves C. Goggles D. Face Shield

B. Gloves According to evidence-based practice, the nurse should first remove the gloves, to reduce the risk of transmitting an infectious agent

A nurse is removing PPE after giving direct care to a client who requires isolation. Which of the following PPE item shoudl the nurse remove first? A. Gown B. Gloves C. Face shield D. Mask

B. Gloves According to evidence-based practice, the nurse should remove the most contaminated item, the gloves, first.

A nurse is washing their hands w/ soap and water prior to repositioning a client in bed. During the handwashing procedure, it is important to take which of the following actions? A. Make sure that the water is hot. B. Wash for at least 20 seconds. C. Use a liquid soap preparation. D. Remove rings and watches first.

B. Handwashing with nonantimicrobial soap and water for at least 20 seconds reduces bacterial counts and can remove loosely adherent transient flora. The Centers for Disease Control and Prevention recommends rubbing hands together vigorously for at least 20 seconds, covering all surfaces of the hands and fingers.

A nurse is preparing a sterile field. Which of the following actions should the nurse perform when opening the sterile pack? A. Place the pack on a sterile work surface. B. Reach around the pack and open the top flap away from the body. C. Open the right flap with the left hand. D. Move to the opposite side of the pack to open the fourth flap.

B. The nurse should pull the uppermost flap away from her body, grasping it from the side to avoid reaching over the sterile field and contaminating it.

A nurse is admitting a client who requires droplet precautions due to influenza. Which of the following actions should the nurse take? A. Place the client in a room with negative airflow. B. Wear a mask when providing care to the client. C. Ensure the client's room has HEPA filtration. D. Wear a gown when providing care to the client.

B. The nurse should wear a mask when within 3 feet of a client who requires droplet precautions.

A nurse is caring for a client who is on contact precautions. Which of the following actions should the nurse take? A. Wear an N95 mask when caring for the client B. Place the client in a private room. C. Place a mask on the client when they leave their room D. Place the client in a negative airflow room

B. Place the client in a private room to reduce risk of transmitting the infectious agent to others.

A nurse is caring for a client who has Mycoplasma pneumoniae. The client has been placed on droplet precautions. Which of the following actions should the nurse take when caring for the client? A. Wear a respirator. B. Protect their eyes. C. Put on clean gloves. D. Wear shoe covers.

B. Protect their eyes. Droplet transmission involves contact of infectious, large-particle droplets with the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person. Droplets are generated by the client during coughing, sneezing, or talking and during procedures such as suctioning and bronchoscopy.

A nurse is assisting with teaching a newly licensed nurse about needlestick injuries. Which of the following instructions shoudl the nurse include? A. Empty sharps containers when they become full. B. Report needlestick inj to the nursing supervisor. C. Engage the safety device on a needle after documenting the medication administration D. Re cap needles after medication administration

B. Report all needlestick inj w/ a contaminated needle immediately to the supervisor and complete paperwork as designated by the healthcare organization

A nurse is performing hand hygiene after caring for a clinet who has Clostridium difficile. Which of the following hand hygiene methods should the nurse use? A. Alcohol-based sanitzer B. Soap and Water C. Iodine solution D. Chlorhexidine solution

B. Soap and Water The nurse should wash their hands with soap and water after caring for a client who has an infection caused by spores, such as Cdiff.

A nurse is caring for a client who has acquired an infection from a visitor. The client is an example of which of the following links in the chain of infection? A. Reservoir B. Susceptible host C. Portal of Entry D. Portal of Exit

B. Susceptible host is the client who becomes a reservoir for the infectious agent

After assisting a newly admitted client w/ removing their shoes and outerwear, the nurse notices what appears to be soil or grime on their hands. Which of the following actions should the nurse take? A. Cleanse their hands with an alcohol-based gel. B. Wash their hands with soap and water. C. Brush off the soil against a cloth surface. D. Use a wet paper towel to remove the soil.

B. The Centers for Disease Control and Prevention recommends washing with soap and water whenever hands are visibly dirty. In this case, it is the combination of friction, running water, and the properties of soap that remove the soil from the hands.

A nurse is planning care for a client who requires airborne precautions. Which of the following actions should the nurse take? A. Provide a positive-pressure airflow room. B. Wear an N95 respirator mask. C. Allow the client to ambulate in the hall. D. Stand 1.8 m (6 feet) away from the client.

B. The nurse should wear an N95 respirator mask or a high-efficiency particulate air (HEPA) filter mask when caring for a client who has an infection that requires airborne precautions, such as disseminated varicella zoster, rubeola, or tuberculosis.

A nurse is supervising a newly licensed nurse to perform hand hygiene. Which of the following actions by the newly licensed nurse indicates an understanding of the procedure? A. Washes their hands for 10sec B. Turns off the faucet w/ a towel C. Uses hot water to wash their hands D. Holds their hands above their elbows while rinsing off the soap

B. Turns off the faucet w/ a towel to reduce the risk of contaminating the hands.

A nurse is caring for a client who has active pulmonary tuberculosis (TB). The client requires airborne precautions and is receiving multidrug therapy. Which of the following precaution should the nurse take to transport the client safely to the radiology department for a chest X-Ray? A. Ask the X-ray technician to come to the client's room to obtain a portable x-ray B. Have the client wear a mask C. Notify the x-ray department that the client requires airborne precautions D. Wear a filtration mask and gloves during transport

B. When a client who has a communicable disease must leave his room, it is important to protect everyone with whom the client comes in contact. Having the client wear a mask protects others from airborne particles should the client cough.

A nurse is about to irrigate a client's wound. Besides gloves, which of the following PPE should the nurse wear? A. A sterile gown B. Goggles C. A face shield D. An N95 respirator

C. A face shield protects the face, mouth, nose, and eyes from any potential splashes of blood or other body fluids. Irrigating a wound has the potential for splashing irrigating fluid containing blood, body fluids, and tissue particles onto the nurse's face.

A nurse is planning to perform a sterile dressing change for a client. Which of the following actions should the nurse plan to take? A. Hold gauze packages 7.6 cm (3 in) above the sterile field. B. Place sterile supplies within the 2.54 cm (1 in) border of the sterile field. C. Use sterile forceps to move the sterile items on the sterile field. D. Position the wrapped package on the bedside table so the outer flap opens towards her.

C. A sterile object remains sterile only if the nurse touches it with another sterile object. This principle guides the nurse in placement of sterile objects and how she should handle them such as using sterile forceps or wearing sterile gloves to handle objects on a sterile field.

A nurse is assisting w/ teaching a group of nurses on processes that can trigger an inflammatory response in the body. The nurse should include that which of the following is an infectious trigger? A. Burn B. Frostbite C. Bacteria D. Radiation

C. Bacteria is an infectious trigger to an inflammatory response. the inflammatory response is the natural defense of the body to a foreign substance, an infectious agent or an irritation

What should the nurse do to maintain standard precautions? A. Rinse gloves that become visibly soiled during use. B. Use an antimicrobial soap for routine handwashing. C. Disinfect hands immediately after removing gloves. D. Keep gloves on when touching environmental surfaces.

C. It is an essential component of standard precautions to disinfect hands immediately after glove removal, which often occurs at the end of a client-care procedure, and hand hygiene is mandated between client contacts. Hand hygiene is required in case the integrity of each glove has been breached, powder or other residue remains on the nurse's hands, or the nurse's hands have been contaminated during glove removal.

A nurse is preparing a sterile field. Which of the following actions should the nurse identify as contaminating the field? A. Place a sterile dressing 5cm(2in) from the border of the sterile field B. Holding a sterile item at just above waist level C. Opening a sterile package over the middle of the sterile field D. Opening the sterile tray by first unfolding the flap farthest from his body.

C. Opening a sterile package over the middle of the sterile field requires reaching into the field, which can result in contamination. The nurse should place the object on the field by approaching the field from an angle.

A nurse is assisting w/ teaching about PPE w/ a newly licensed nurse. Which if the following instructions should the nurse include? A. Gowns can be reused on the same client B. Mask should be removed after leaving a clients room C. Gloves should be removed from the inside out. D. Eyeglasses can be used in place of goggles.

C. Remove gloves from the inside out to reduce risk of transmission of infectious agents

A nurse is caring for a client who has an infection. The nurse should use which of the following strategies to prevent the transmission of the clients infection? A. Changing the client's bed linens each day B. Encouraging the client to consume a high-protein diet C. Performing hand hygiene before, during, and after direct contact with the client D. Placing the client in a room with positive-pressure airflow

C. The nurse can help prevent the transmission of micro-organisms by washing her hands frequently before, during, and after client care procedures.

A nurse is caring for a client who a methicillin-resistant Staphylococcus aureus (MRSA) in an abd wound. The nurse enters the room to check the client' pulse. Which of the following actions should the nurse take? A. Wear an N95 respirator mask. B. Wear sterile gloves. C. Wear clean gloves. D. Wear protective eyewear.

C. The nurse should wear clean gloves to prevent the transmission of MRSA.

Which of the following products can affect the permeability of latex gloves? A. Antimicrobial soap and water B. Alcohol-based antiseptic gel C. Petroleum-based hand lotion D. Water-based hand lotion

C. The use of petroleum-based hand lotions or creams can impair the integrity of latex gloves, weakening them and increasing their permeability.

A nurse on a medical unit is teaching a group of assistive personnel about handling client's bed linens safely. Which of the following instructions should the nurse include? A. Return any fresh linen not used for a client to the linen supply area. B. Use double bagging to remove soiled linen from the client's room. C. Tie linen bags securely at the top. D. Fill linen bags with as much soiled linen as possible.

C. This action secures the linen inside the bag, keeping any soiled linen from contaminating surfaces or the hands of whoever has to pick it up and bag it again.

Modes of transimission

Contact ◯ Direct physical contact: Person to person ◯ Indirect contact with an inanimate object: Object to person ◯ Fecal‑oral transmission: Handling food after using a restroom and failing to wash hands ● Droplet: Sneezing, coughing, and talking ● Airborne: Sneezing and coughing ● Vector borne: Animals or insects as intermediaries (ticks transmit Lyme disease; mosquitoes transmit West Nile and malaria)

Contact precautions should be implemented for an adult client who has been hospitalized and has which of the following? A. Hepatitis B B. Measles C. Meningitis D. Infectious diarrhea

D Contact precautions are essential for preventing the spread of certain enteric infections. These precautions mean no direct touching of the client, the environment, the equipment, or the supplies used. The client should also be placed in a private room.

A charge nurse is reviewing guidelines for initiating airborne precautions. Which of the following clients should the nurse identify as requiring airborne precautions? A. A client who has scabies B. A client who has pertussis C. A client who has streptococcal pharyngitis D. A client who has measles

D. A client who has measles requires airborne precautions as well as a negative pressure room A client who has scabies requires contact precautions. A client who has pertussis requires droplet precautions. A client who has streptococcal pharyngitis requires droplet precautions.

A nurse is assisting w/ teaching a newly licensed nurse about infection control. The nurse should include in the teaching that which of the following types of precautions requires the use of an N95 mask? A. Protective isolation B. Contact C. Droplet D. Airborne

D. Airborne caused by small droplets in the air, such as measles or chickenpox

A nurse is reviewing the lab results of a client who has a pressure ulcer. The nurse should identify an elevation in which of the following lab values as an infection that the client has developed an infection? A.BUN B. Potassium C. RBC count D. WBC count

D. An elevation in the WBC count (leukocytosis) indicates that the client's immune system is defending him against the pathogens causing an infection.

A clinical nurse educator is preparing an educational program about transmission of methicillin-resistant Staphylococcus aureus(MRSA) in hospitalized clients. Which of the following information should the nurse include in the program? A. Place clients who have MRSA on airborne precautions. B.MRSA can be effectively treated with an antiviral medication. C.MRSA can live on the hands for 1 hr. D. Bathe clients with water and chlorhexidine gluconate

D. Bathing hospitalized clients with premoistened cloths or warm water that is mixed with chlorhexidine gluconate significantly decreases infection with MRSA.

A nurse is reviewing the medical record for a client who has a health care-associated infection (HAI). The nurse should identify which of the following findings as a risk factor for acquiring an HAI? A. The client had an appendectomy 6 months ago. B. The client has bipolar disorder. C. The client is a male. D. The client is 71 years old.

D. Clients older than 70 years of age are at an increased risk of acquiring an HAI. Decreased immune system function increases the susceptibility to infection.

A nurse is wearing gloves while caring for a client. In which of the following situations should the nurse obtain a new pair of gloves? A. After donning a gown and before collecting vital signs on the client B. After removing food items off the client's tray and before removing soiled linens from the client's bed. C. After helping the client stand up and before helping them brush their teeth. D. After changing a dressing on the client and before documenting findings on a computer.

D. The nurse should change the glove sot avoid contamination from the client to the keyboard or computer, and in between clients

A nurse is caring for a client who requires droplet precautions. Which of the following PPE equipment should the nurse wear when setting up the client's meal tray? A. Gloves B. Goggles C. Gown D. Mask

D. Mask should be worn whenever she is within 3 ft of the client

A nurse is assisting w/ teaching a newly licensed nurse about surgical asepsis. Which of the following statements should the nurse make? A. " You can wear artificial fingernails if they are kept short" B. "Leave rings on your fingers when performing surgical hand asepsis." C. "Keep your fingernails less than an inch in length" D. " Remove nail polish on your fingernails if its chipped"

D. Nail polish if worn, should not be chipped because the chipped areas can harbor bacteria

A nurse is teaching a newly hires group of assistive personnel (AP) about infection-control measures on the unit. It is crucial for the nurse to remind the APs that which of the following is the most effective way to prevent the spread of pathogens during client care? A. Properly disposing of contaminated equipment B. Discarding used syringes in appropriate containers C. Changing soiled linens daily for clients who have draining wounds D. Performing hand hygiene frequently and consistently

D. Performing hand hygiene frequently and consistently. The greatest risk to all clients and staff on the unit is infection from cross contamination; therefore, the priority action is hand hygiene. It is one of the most important and effective ways to prevent pathogen transmission. It applies to every health care setting and is a consistent imperative during client care.

A nurse in a clinic is caring for a client who reports generalized aches and fever for the past 12 hours. The nurse suspects the client has acquired an infection. Which of the following stages of infection is the client likely experiencing? A. Incubation B. Convalescence C. Acute Illness D. Prodromal

D. Prodromal the second stage, where the client begins having vague, nonspecific manifestations, such as fever, chills, headaches, and malaise, as the infectious agent replicates.

A nurse is admitting a client who has TB and a productive cough. Which of the following types of isolation precautions should the nurse initiate for the client? A. Contact B. Droplet C. Protective D. Airborne

D. The nurse should initiate airborne precautions when a client has an infection that spreads through small droplets that remain airborne for longer periods, such as tuberculosis and measles. The client requires a negative-pressure airflow room, and staff should wear an N95 respirator when in contact with the client.

How to set up a sterile field

EQUIPMENT ● Select a clean area above waist level in the client's environment (a bedside stand) to set up the sterile field. ● Check that all sterile packages (additional dressings, sterile bowl, sterile gloves, and solution) are dry and intact and have a future expiration date. Any chemical tape must show the appropriate color change. ● Make sure an appropriate waste receptacle is nearby. PROCEDURE Perform hand hygiene. STERILE FIELD SETUP ● Open the covering of the package per the manufacturer's directions, slipping the package onto the center of the workspace with the top flap of the wrapper opening away from the body. ● Grasp the tip of the top flap of the package, and with the arm positioned away from the sterile field, unfold the top flap away from the body. ● Next, open the side flaps, using the right hand for the right flap and the left hand for the left flap. ● Grasp the last flap and turn it down toward the body. ADDITIONAL STERILE PACKAGES ● Open next to the sterile field by holding the bottom edge with one hand and pulling back on the top flap with the other hand. Place the packages that will be used last furthest from the sterile field; open these first. ● Add them directly to the sterile field. Lift the package from the dry surface, holding it 15 cm (6 in) above the sterile field, pulling the two surfaces apart, and dropping it onto the sterile field.

Define surgical asepsis

Eliminated all micro-organisms from an an object or area and prevent contamination Referred to as "sterile technique" Used in : Parenteral medication administration Dressing changes Catheterizations surgical procedures

A nurse is wearing PPE and is preparing to leave a client's room after providing care. After untying the ties at the waist of the gown, which of the following actions should the nurse take? A. Remove the mask B. Remove the protective eyewear C. Remove the gloves D. Remove the gown

First, the nurse should remove the gloves. The nurse should remove the first glove by grasping the cuff and pulling the glove inside-out over hand, pulling it completely off by rolling the glove inside out. This will prevent contamination of the skin. Hold this glove with the fingers of the gloved hand. With ungloved hand, tuck 2 fingers inside the cuff of the remaining glove, and then pull it off to the fingers and inside out over the first glove. With the bare hand continue removing the gloves and dispose of them. As both gloves are inside out this will prevent contamination of the skin. The nurse should then perform hand hygiene to remove microorganism. Next the nurse should remove the eyewear. After removing the eyewear, the nurse should remove the gown. The nurse should first untie the neck and waist strings, then remove the gown by touching only the inside of the gown in order to prevent contamination. Remove hands from sleeves without touching outside of gown. Hold gown inside at shoulder seams, and fold it inside-out. Discard in appropriate receptacle. Finally, the nurse should remove the mask. If the mask loops over the ears, the nurse should lift the loops up and away from the face and ears without touching the front of the mask. For a tie-on mask, the nurse should untie and hold onto the top strings, untie bottom strings, pull the mask away from the face and then drop it into the trash receptacle. Do not touch the outer surface of the mask. The nurse should then perform hand hygiene again.

Diagnostic Procedure for infections

Gallium scan: Nuclear scan that uses a radioactive substance to identify hot spots of WBCs ● Radioactive gallium citrate: Injected by IV and accumulates in area of inflammation ● X‑rays, CT scan, magnetic resonance imaging (MRI), and biopsies to determine the presence of infection, abscesses, and lesions

Doffing PPE

Gloves Goggles Gown Mask Hand hygiene

contact precautions

Gloves and gown Contact precautions protect visitors and caregivers when they are within 3 ft of the client against direct client and environmental contact infections (respiratory syncytial virus, shigella, enteric diseases caused by micro‑organisms, wound infections, herpes simplex, impetigo, scabies, multidrug‑resistant organisms). Contact precautions require: ● A private room or a room with other clients who have the same infection. ● Gloves and gowns worn by the caregivers and visitors. ● Disposal of infectious dressing material into a single, nonporous bag without touching the outside of the bag.

Donning on PPE

Gown Mask Goggles/face shield Gloves GMGG

Passive Immunity

Immunity you acquire from some or something else Natural: Antibodies transmitted from mother to baby Artificial: Antibodies acquired from an immune serum medicine

active immunity

Immunity you develop after being exposed to an infection or from getting a vaccine Natural: Antibodies made after exposure to an infection Artificial: Antibodies made after getting a vaccination

Stages of infection

Incubation period Prodromal stage Full stage or illness Convalescent period

Risk waste consist of:

Infectious waste Pathological waste Sharps Pharmaceutical waste Genotoxic waste Chemical Waste Radioactive Waste

What are the 3 levels of immunity?

Level 1: Barriers; skin and cilia prevent invader from entering Level 2: Innate; Cells and chemicals stop invaders from spreading Level 3: Adaptive- Blood warriors attack invaders

Types of Pathogens and diseases they cause

Pathogens are the micro‑organisms or microbes that cause infections. ● Bacteria (Staphylococcus aureus, Escherichia coli, Mycobacterium tuberculosis) ● Viruses: Organisms that use the host's genetic machinery to reproduce (HIV, hepatitis, herpes zoster, herpes simplex virus [HSV]) ● Fungi: Molds and yeasts (Candida albicans, Aspergillus) ● Prions: Protein particles (new variant Creutzfeldt‑Jakob disease) ● Parasites: Protozoa (malaria, toxoplasmosis) and helminths (worms [flatworms, roundworms], flukes [Schistosoma]) Herpes zoster is a common viral infection that erupts years after exposure to chickenpox and invades a specific nerve tract.

prodromal stage

Person is most infectious, vague and nonspecific signs of disease; interval from onset of general findings to more distinct findings; during this time, the pathogen

How to maintain a sterile field

Prolonged exposure to airborne micro‑organisms can make sterile items non-sterile. ● Avoid coughing, sneezing, and talking directly over a sterile field. ● Advise clients to avoid sudden movements; refrain from touching supplies, drapes, or the nurse's gloves and gown; and avoid coughing, sneezing, or talking over a sterile field. Only sterile items can be in a sterile field. ● The outer wrappings and 1‑inch edges of packaging that contains sterile items are not sterile. The inner surface of the sterile drape or kit, except for that 1‑inch border around the edges, is the sterile field to which other sterile items can be added. To position the field on the table surface, grasp the 1‑inch border before donning sterile gloves. Discard any object that comes into contact with the 1‑inch border. ● Touch sterile materials only with sterile gloves. ● Consider any object held below the waist or above the chest contaminated. ● Sterile materials can touch other sterile surfaces or materials; however, contact with non-sterile materials at any time contaminates a sterile area, no matter how short the contact. Microbes can move by gravity from a non-sterile item to a sterile item. ● Do not reach across or above a sterile field. ● Do not turn your back on a sterile field. ● Hold items to add to a sterile field at a minimum of 6 inches above the field. Any sterile, non-waterproof wrapper that comes in contact with moisture becomes non-sterile by a wicking action that allows microbes to travel rapidly from a nonsterile surface to the sterile surface. ● Keep all surfaces dry. ● Discard any sterile packages that are torn, punctured, or wet.

Findings during the first stage of the inflammatory response (local infection) include the following.

Redness (from dilation of arterioles bringing blood to the area) ■ Warmth of the area on palpation ■ Edema ■ Pain or tenderness ■ Loss of use of the affected part

Define medical asepsis

Reduces the number, growth and spread of micro-organisms Referred to as "clean technique" Used in administration of: Medication Enemas Tube Feedings Daily hygiene *** HAND WASHING IS # 1****

Specific adaptive immunity

Specific adaptive immunity allows the body to make antibodies in response to a foreign organism (antigen). This reaction directs against an identifiable micro‑organism.

Droplet precautions

Surgical mask Droplet precautions protect against droplets larger than 5 mcg and travel 3 to 6 ft from the client (streptococcal pharyngitis or pneumonia, Haemophilus influenzae type B, scarlet fever, rubella, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia and sepsis, pneumonic plague). Droplet precautions require: ● A private room or a room with other clients who have the same infectious disease. Ensure that clients have their own equipment. ● Masks for providers and visitors. ● Clients who have a droplet infection should wear a mask while outside of the room/home.

A nurse is assisting a provider w/ a sterile procedure and prepares to pour solution onto a piece of sterile gauze. In what order should the nurse perform the following steps when pouring sterile solution? 1.Remove the bottle cap 2. Pick up the bottle w/ label facing toward the palm 3. Perform hand hygiene 4. Pour 1 to 2 mL into a receptacle 5. Pour the solution onto the gauze 6. Place the bottle cap face-up on a clean surface

The nurse should first perform hand hygiene before assisting with the procedure as part of medical asepsis to reduce the growth and transmission of infectious agents. The nurse should then remove the bottle cap carefully to avoid touching inside the cap and the bottle, because these areas are sterile. After removing the cap, the nurse should place it with the inside of the cap face-up on a clean surface, because it is sterile on the inside. The nurse should pick up with the label against the palm of the hand This prevents the solution from running down the side of the bottle, which may damage the label. The nurse should then pour 1 to 2 mL of solution into a receptacle to be discarded. This cleans the inside lip of the bottle. The final step is to pour the solution onto the sterile gauze. The nurse should not hold the bottle over the sterile field. Make sure the lip of the bottle does not come into contact with the sterile gauze. Hold the bottle high enough to avoid splashing of the solution.

A nurse is assisting a provider w/ a sterile procedure and prepares to pour solution onto a piece of sterile gauze. In what order should the nurse perform the following steps when pouring sterile solution? 1.Remove the bottle cap 2. Pick up the bottle w/ label facing his palm 3. Pour 1 to 2 mL into a receptacle 4. Pour the solution onto the gauze 5. Place the bottle cap face-up on a clean surface

The nurse should first remove the bottle cap in preparation for pouring the solution. He should not touch the inside of the cap because it is sterile. Next, he should place the bottle cap face up on clean surface. A bottle containing a sterile solution is sterile on the inside, but the outside is not. The outside of the bottle cap is also not sterile, but the inside of the cap is. Therefore, when he removes the cap, he should place it open end up on a clean surface, not on the sterile field. Next, he should pick up the bottle with the label facing his palm. This prevents the solution from running down the side of the bottle, which can wet and blur the printing on the label. Next, he should pour 1 to 2 mL of solution into a receptacle to discard later. This cleans the inside lip of the bottle in preparation for the next pouring of the solution, the final step, which is onto the sterile surface of the gauze.

A nurse if preparing to exit the room of a client who has methicillin-Staphylococcus aureus(MRSA) in a draining wound. Identify the sequence the nurse should follow before leaving the client's room. 1. Perform hand hygiene 2. Remove the face mask 3. Remove the gown 4. Remove the gloves 5. Remove the eyewear

The nurse should remove the most contaminated item of PPE first and the least contaminated item last. The gloves are the most contaminated, so the nurse should remove them first, and then the eyewear, the gown, and finally, the mask. Finally, the nurse should perform hand hygiene and then leave the room.

Types of Precautions for infection control

Tier 1 :Standard Tier 2 :Transmission-based Contact Airborne Droplet Protective

Protective Environment intervention/precaution

Tier 2 Protective environment is an intervention (not type of precautions) to protect clients who are immunocompromised. This includes clients who have had an allogeneic hematopoietic stem cell transplant. A protective environment requires: ● Private room. ● Positive airflow 12 or more air exchanges/hr. ● HEPA filtration for incoming air. ● Mask for the client when out of room.

Virulence

Virulence is the ability of a pathogen to invade and injure a host.

incubation period

organisms growing and multiplying; interval between the pathogen entering the body and the presentation of the first finding

What is immunity?

resistance to a disease causing organism or harmful substance

nonspecific (innate) defenses native

restricts entry or immediately responds to a foreign organism (antigen) through the activation of phagocytic cells, complement, and inflammation. This occurs with all micro‑organisms, regardless of previous exposure.

Findings during the second stage of the inflammatory response (local infection) include the following.

the micro‑organisms are killed. Fluid containing dead tissue cells and WBCs accumulates and exudate appears at the site of the infection. The exudate leaves the body by draining into the lymph system. The types of exudate are: ■ Serous (clear). ■ Sanguineous (contains red blood cells). ■ Purulent (contains leukocytes and bacteria).

Health care-associated infections (HAIs)

•Aka-nosocomial infections •Can occur exogenous or endogenous •Client acquires while in health care •Prevention: Hand hygiene •Iatrogenic: results from diagnostic/therapeutic procedure •Not always preventable

Maintaining surgical asepsis

•Maintaining sterile field •Decrease prolonged exposure to airborne micro-organisms •Sterile items on sterile field •1 inch edge •Above waist •Below chest •Do not cross field •Do not turn back •6 inches above field to hold items

Standard Precautions

•Tier 1 •Hand hygiene When? -Remove gloves and complete hand hygiene between each client. Hand hygiene using nonantimicrobial soap or an antimicrobial soap and water is recommended when visibly soiled or contaminated with blood or body fluids. ● Alcohol‑based waterless antiseptic is preferred unless the hands are visibly dirty, because the alcohol‑based product is more effective in removing micro‑organisms •Applies to all body fluids, non-intact skin, mucous membranes •Considered potentially infectious •Used for all clients •Splashing- masks, eye protection, face shields •Clean gloves •Proper equipment cleaning •Dispose of all sharps

Airborne precautions

•Transmission based- tier 2 N95, gloves and gown Use airborne precautions to protect against droplet infections smaller than 5 mcg (TB, Covid, measles, varicella, pulmonary or laryngeal tuberculosis).. •Protect infections smaller than 5mcg •N95 -Masks and respiratory protection devices for caregivers and visitors •Private Room- negative pressure airflow exchange in the room of at least six to 12 exchanges per hour, depending on the age of the structure. •Patient transport- patient wears mask •Gloves and gown

Findings identifiable in the nursing assessment of generalized or systemic infection include the following in OLDER ADULT CLIENTS

◯ Older adults have a reduced inflammatory and immune response and thus might have an advanced infection before it is identified. Atypical findings (agitation, confusion, or incontinence) can be the only manifestations. ◯ Other findings can vary depending on the site of the infection (dyspnea, cough, purulent sputum, and crackles in lung fields, dysuria, urinary frequency, hematuria and pyuria, rash, skin lesions, purulent wound drainage, erythema and odynophagia, dysphagia, hyperemia, enlarged tonsils, change in level of consciousness, nuchal rigidity, photophobia, headache).